Alfred Gatt

University of Malta · Faculty of Health Sciences

Measurement of ankle joint dorsiflexion is an essential examination technique that needs to be performed prior to prescription of foot orthoses since the presence or absence of ankle equinus will affect the design of such devices. The purpose of this study was to investigate the effect of foot posture on sagittal plane kinematics of various foot se...

Objectives. To collect normative baseline data and identify any significant differences between hand and foot thermographic distribution patterns in a healthy adult population. Design. A single-centre, randomized, prospective study. Methods. Thermographic data was acquired using a FLIR camera for the data acquisition of both plantar and dorsal aspe...

Background: The assessment of the maximum ankle dorsiflexion angle is an important clinical examination procedure. Evidence shows that the traditional goniometer is highly unreliable, and various designs of goniometers to measure the maximum ankle dorsiflexion angle rely on the application of a known force to obtain reliable results. Hence, an inn...

Background Functional Hallux Limitus (FHL) is diagnosed with a static test known as the Hubscher Manoeuvre, the validity of which has been previously questioned. Objective/s To investigate the validity of this manoeuvre and whether introducing severity of pronation as a second concurrent test would increase this validity. Method 30 participants w...

Background: We investigated the effectiveness and durability of two types of plantar padding, the plantar metatarsal pad and the single wing plantar cover, which are commonly used for reducing forefoot plantar pressures. Methods: Mean peak plantar pressure and impulse at the hallux and at the first, second, third, and fourth metatarsophalangeal...

Background: The epidemiology data and global burden of diabetic foot disease underscores the need for effective prevention strategies, which requires an early diagnosis. Patient-reported outcome measures are instruments based on a simple format, which favours their application. Currently, there is an absence of instruments with a broad enough scope...

Rowing is a sport that requires athletes to perform the action of pulling and rotating an oar by hand, applying forces of considerable magnitude. Herein, inspired by the notion that auxetic materials and metamaterials behave differently compared to their conventional counterparts, it is examined how a handle prototype, specifically designed to inco...

This study determined the requisite process parameters for good-quality screw extrusion additive manufacturing (AM) of thermoplastic polyolefin (TPO) using fused granulate fabrication (FGF). TPO is a non-hygroscopic, cheaper, and less dense alternative to the well-established thermoplastic polyurethane (TPU). TPO was found to extrude correctly at 1...

This study compared the outcome of an innovative in-shoe pressure and temperature measuring device as an adjunct to standard clinical care for diabetic foot versus standard clinical care alone. It included 88 participants with Type 2 diabetes mellitus with a history of one or more plantar foot ulceration who were already using prescription orthoses...

Despite technological and medical advances, amputations continue to increase. Amputees face significant challenges when acquiring and using prosthetic devices, challenges which are made worse as their emotional needs, aspirations, mobility, prosthesis requirements and problems change over time. These challenges require custom solutions for each ind...

Objectives: To investigate the efficacy of the assessment methods that are used to diagnose posterior tibialis tendon dysfunction (PTTD) and investigate how the results of these assessments can be used to instruct non-surgical treatments. Design: Systematic review. Data sources: Searches were conducted up to January 2023 in the PubMed, Scopus, Scie...

Despite medical and technological advancements, foot amputations continue to rise. Thus, the effort of diabetic foot management should be toward prevention and early diagnosis. Healthcare professionals need to be trained, equipped, and supported with adequate resources to be able to identify and deliver appropriate foot care. Every effort should be...

Introduction The objective of this study was to carry out the cross-cultural adaptation and validation of the Diabetic Foot Self-Care Questionnaire into the English language, broadening the applicability of this patient-reported outcome measure and improving the monitoring of patients with diabetic foot disease. Methods The validation study into E...

Background: Studies have shown that personal and economic reasons determine whether clinicians use diagnostic technology in their routine clinical biomechanical practice. This study aimed to identify the biomechanical management plan of local clinicians in relation to management of the diabetic high-risk foot and to investigate whether diagnostic t...

Aim: To compare mental health status and quality of life in lower-limb amputees versus nonamputees among participants with diabetes mellitus. Methods: We included 38 participants with prior minor amputation (group 1) and 38 participants without amputation /history of amputation (group 2). These were interviewed twice using 2 questionnaires to sc...

Background: To perform laboratory static validation of pressures from an innovative, single-sensor pressure and temperature monitoring device for the early detection of complications in the high-risk foot. Research question: Can an innovative, newly developed, in-shoe pressure and temperature measuring device, detect and measure the in-shoe peak...

The behaviour of an indenter having a hard inner core and a softer outer shell, meant to emulate a human finger, pressing upon a sample covered with an isotropic negative/zero/positive Poisson’s top protective layer was investigated through static finite-element simulations. It was shown that if the material being indented had a comparable Young’s...

Amputees face a number of challenges when acquiring and using a prosthesis, with major issues being the cost of the device, the time it takes for their custom prosthesis to be developed and delivered, as well as the challenges they face to get it regularly serviced and maintained. The other stakeholders involved, including the prosthetists and stan...

Background: Managing and rehabilitating Achilles tendinopathy can be difficult, and the results are often unsatisfactory. Currently, clinicians use ultrasonography to diagnose the condition and predict symptom development. However, relying on subjective qualitative findings using ultrasound images alone, which are heavily influenced by the operato...

Despite huge medical and technological advances to date for the diagnosis, monitoring, and management of diabetic foot complications, their prevalence is still alarmingly high. Patients’ quality of life may be severely compromised. Patients may fear amputations more than death. An effort to minimize the impact of these complications and to ensure p...

Supersonic shear wave (SW) elastography has emerged as a useful imaging modality offering researchers and clinicians a fast, non-invasive, quantitative assessment of tendon biomechanics. However, the exact relationship between SW speed and in vivo tendon stiffness is not intuitively obvious and needs to be verified. This study aimed to explore the...

This work presents a qualitative and quantitative pilot study which explores the kinematics of Venetian style forward-facing standing rowing as practised by able-bodied competitive athletes. The technique, made famous by the gondoliers, was replicated in a biomechanics laboratory by a cohort of four experienced rowers who compete in this style at N...

Background: The purpose of this study was to evaluate the effectiveness of tap water iontophoresis as a treatment for plantar hyperhidrosis. Methods: Thirty participants living with idiopathic plantar hyperhidrosis and consented to undergo treatment using iontophoresis were recruited. The Hyperhidrosis Disease Severity Score was used to evaluate th...

Background: The purpose of this study was to evaluate plantar pressure dynamics in the occurrence of active diabetic neuropathic ulceration (DNU) and any changes in loadings occurring in individuals with a history of diabetic neuropathic ulceration (DHNU). Since current gold standard offloading strategies are not producing desirable healing outcom...

Background Available technology to detect the 2 primary predictors of ulceration is not being used as it is deemed as costly and time-consuming. Thus, the aim of this study was to determine dynamic laboratory validation, of an innovative, single-sensor in-shoe device that can read peak pressure and temperature simultaneously. Research question Can...

Amputees face challenges with prosthesis such as cost, long delivery periods, as well as social discomfort. Simultaneously, the prosthetists and manufacturers have a difficulty to handle such diverse issues. We thus contribute a Prosthetic Life-Cycle Service System (ProLiSS) Framework, prescribed to involve amputees in different life phases. From a...

Background: Toe deformities are common foot abnormalities in older adults, contributing to functional disability, loss of balance, falls, and pressure lesions. The aim of this study was to evaluate the effectiveness of the custom-made molded silicone toe prop in distributing apical and metatarsophalangeal joint peak plantar pressures and force-time...

Background: Metatarsalgia is a common affliction in rheumatoid arthritis (RA), often requiring aggressive pharmacologic treatment that carries associated adverse effects. The aim of this study was to investigate whether simple insoles would have a beneficial effect on forefoot pain, disability, and functional limitation in participants with RA expe...

Background and Objectives: Rowing is a sport that involves constant gripping, pulling/pushing, and rotational movements of the hands, in a cyclic periodic manner with every stroke, with hundreds of strokes being taken within a short period of time. Dermatological issues on rowers’ hands (fingers and palms) in the form of blisters and calluses are c...

Background: Although the awareness, diagnosis, management of the complications associated with diabetes have improved in African countries over the past decade, surveillance activities in Tanzania and anecdotal reports from other African countries have suggested an increased prevalence of Charcot Neuroarthropathy (CN) over the past few years. Aim:...

Background Podiatrists, in musculoskeletal services, are demonstrating an expansion of their practice skills through the use of ultrasound imaging. There is an assumption that this practice is beneficial within the context of patient care and health systems. The aim of this research was to further investigate the use of musculoskeletal ultrasound (...

PurposeDiabetic foot disease is one of the most serious and expensive complications of diabetes. Patient-reported outcome measures (PROMs) analyse patients’ perception of their disability, functionality and health. The goal of this work was to conduct a systematic review regarding the specific PROMs related to the evaluation of diabetic foot diseas...

This study aimed to determine the most accurate microbiological test for the detection of micro-organisms in infected diabetic foot ulcerations in people living with type-2 Diabetes. For 20 eligible patients, a superficial tissue swab and a deep tissue sample were taken during a regular appointment at a Diabetes out-patient's Podiatry Clinic. Two s...

Elevated foot pressure and high temperatures have been proposed as predictive factors for diabetic foot ulceration; however, on their own, their predictive value is still questionable. This pilot study hypothesized that combining these two measurements in a thermo-pressure model could result in a more reliable risk assessment tool for providing ris...

Background: Malta is an obesogenic country with low levels of daily moderate-to-vigorous physical activity (MVPA) reported amongst Maltese children. Schools play a significant cost-effective role in delivering and encouraging physical activity and thus contributing to population health. So far, there were no specific school-based physical activity...

Background The aim of this study was to analyse the effect of induced lower limb joint restriction on plantar pressures during gait. Focusing on restricting a single joint, without the effect of other co-morbidities, would provide better understanding as to the resultant plantar loadings during gait, which would be especially beneficial in patients...

Background: Peripheral artery disease (PAD) and diabetes mellitus are factors known to influence gait characteristics. However, there is a lack of knowledge on the extent to which type 2 diabetes mellitus (T2D) and PAD as comorbidities cause limb and gait complications. Aim: The purpose of this study was to investigate the impact of PAD as a com...

Background In diabetic foot ulceration, a correlation between pressure and skin temperature is suspected. The aim of this systematic review is to provide a more rigorous analysis of existing literature related to the various technologies used to read and measure both in-shoe plantar pressures, and in-shoe skin temperatures simultaneously. Methods...

Objectives Studies have shown conflicting characteristic thermographic patterns of the feet in patients with active rheumatoid arthritis (RA). However, to date no studies have compared thermographic patterns of patients with RA in remission and healthy controls. Thus this study aimed to investigate whether the thermal characteristics of the feet of...

Background: To evaluate the effect of smoking on arterial perfusion and to determine whether smoking cessation would result in a significant improvement on the circulation of persons living with type 2 diabetes mellitus (T2DM). Methods: A nonexperimental comparative quantitative research was conducted amongst 32 participants with type 2 diabetes...

Background: The need to classify, score and describe diabetic foot ulcerations is needed for accurate clinical documentation. An agreed wound classification can improve communication between health care professionals, and improve ease of discussion regarding potential outcomes. This study aimed to determine the inter-rater reliability between four...

Aim: The study aimed to investigate the possible relationship between diabetic peripheral neuropathy (DPN) and the development of depressive symptoms in patients with type 2 diabetes mellitus (T2D). Methods: A comparative non-experimental study was conducted. Ninety-five T2D individuals aged 65 years and more were recruited. The sample was divid...

BACKGROUND Malta is currently facing a childhood obesity epidemic. Almost 40% of primary and 42% of secondary school children are overweight or obese secondary to energy imbalances and increase in sedentary behaviour. Physical inactivity is another risk factor for childhood obesity and hence adult obesity, leading to various physical, psychologica...

The use of foot mounted inertial and other auxiliary sensors for kinematic gait analysis has been extensively investigated during the last years. Although, these sensors still yield less accurate results than those obtained employing optical motion capture systems, the miniaturization and their low cost have allowed the estimation of kinematic spat...

Background: Worldwide, substance use disorder is on the rise, especially amongst the young generation. Although cocaine-induced cardiovascular and cerebrovascular events are well documented, knowledge about the relationship of cocaine use and its effect on arterial perfusion in the lower limbs is scarce. Objective: This study sought to investigate...

Background Plantar pressure reduction with the use of cushioning materials play an important role in the clinical management of the diabetic foot. Previous studies in people without diabetes have shown that appropriate selection of the stiffness of such materials can significantly enhance their capacity to reduce pressure. However the significance...

Background First-line therapy for diabetic patients presenting with intermittent claudication includes supervised exercise programs to improve walking distance. However, exercise comes with a variety of barriers and may be contraindicated in certain conditions. The aim of this study was to evaluate whether calf muscle electrostimulation improves cl...

Thermal imaging has been applied to detect possible temperature variations in various rheumatic disorders. This study sought to determine whether rheumatoid arthritis (RA) patients without active synovitis in their hands exhibit different baseline thermographic patterns of the fingers and palms when compared to healthy individuals. Data from 31 RA...

Background: The aim of the present study was to explore the variation in the provision of care for people with rheumatic and musculoskeletal diseases (RMDs), and foot and ankle problems between European healthcare systems. Methods: An electronic questionnaire was developed and piloted in seven countries prior to being distributed to the presiden...

Background: Kinematic gait analysis employing multi-segment foot models has been mainly conducted in laboratories by means of optical motion capture systems. This type of process requires considerable setup time and is constrained by a limited capture space. A procedure involving the use of multiple inertial measurement units (IMUs) is proposed to...

Background and Aim This single-centre study aimed to determine healing, re-ulceration, re-amputation and mortality rates at one year after toe amputations in patients with type 2 diabetes (T2DM). Patients and Methods Eighty-one participants with T2DM admitted for toe amputation were included. Patient characteristics, peripheral circulation and neur...

Aim: The stiffness of cushioning materials used in therapeutic footwear/orthoses play an important role for effective protection against tissue overloading and injury[1]. 3D-printing offers new capabilities for adapting the design and the stiffness of footwear/orthoses to the specific needs of individual patients. The importance of subject-specific...

Background Malta is currently struggling through a childhood obesity epidemic, having the highest overweight and obesity rates in Europe and North America. The enrolment of schools to provide adequate levels of moderate-to-vigorous physical activity (MVPA) levels during physical education (PE) lessons, through a structured PE curriculum, has not ye...

Aim To compare temperature changes following a challenge of limb elevation, in 3 forefoot angiosomes between type 2 diabetes mellitus patients with and without peripheral arterial disease (PAD). Methods Participans were categorized in a no PAD, mild PAD or severe PAD group. All underwent thermal imaging, then successive thermal images were taken at...

Background: In vitro biomechanical testing of the human foot often involves the use of fresh frozen cadaveric specimens to investigate interventions that would be detrimental to human subjects. The Thiel method is an alternative embalming technique that maintains soft-tissue consistency similar to that of living tissue. However, its suitability fo...

This work develops a method for automatically extracting temperature data from prespecified anatomical regions of interest from thermal images of human hands, feet, and shins for the monitoring of peripheral arterial disease in diabetic patients. Binarisation, morphological operations, and geometric transformations are applied in cascade to automat...

Various clamp designs have been proposed over the years with different degrees of complexity and actual performance vis‐à‐vis correct grip and reduced impact on the surface strains of the tendon sample. The previous studies all focused on impact on ultimate tensile strain and Young's modulus of the tendons. Here an innovative clamp design is propos...

Background: Healthcare options for people with diabetes is still not uniform both within and between countries. This is particularly evident for diabetic foot disease. The number of existing documents/guidelines, together with discrepancies which exist between different organizations or countries can lead to confusion for both practicing health ca...

Aim: The aim of this study was to compare different screening modalities in the detection of PAD in a primary care setting. Methods: Fifty participants living with Type 2 diabetes were recruited. Pulse palpation, waveform analysis, ankle brachial pressure index, absolute toe pressure, toe brachial pressure index and transcutaneous oxygen pressur...

Background and Aims Several treatment modalities and protocols for ischaemic foot ulcers are available. However, little consensus exists on optimal treatment. The aim of this study was to compare Standard Wound Care (SWC) alone vs. SWC with adjunct hyperbaric oxygen therapy (HBOT) in the treatment of ischaemic Diabetic Foot Ulcers (DFUs). Patients...

Background: Spectral Doppler ultrasound examination of pedal arteries is one of the most frequently used noninvasive assessment methods by health-care professionals for the diagnosis and ongoing monitoring of people at risk for or living with peripheral arterial disease. The aim of this study was to determine the interrater reliability of the inte...

This study aimed to determine whether thermal imaging can detect temperature differences between healthy feet, nonulcerated neuroischemic feet, and neuroischemic feet with toe ulcers in patients with type 2 diabetes mellitus (T2DM). Participants were prospectively divided into 3 groups: T2DM without foot problems; a healthy, nonulcerated neuroische...

Background Thermography has been utilised in a number of studies in rheumatoid arthritis (RA),¹ however there is a paucity of evidence as regards to the possibility of applying this non-invasive technology to the detection of synovitis of the hands and wrists. With normative data having been already published,² it is now possible to compare the the...

Aim To evaluate the potential of thermography as an assessment tool for the detection of foot complications by understanding the variations in temperature that occur in type 2 diabetes mellitus (DM). Methods Participants were categorized according to a medical examination, ankle brachial index, doppler waveform analysis, and 10-gram monofilament t...

Aims: The purpose of this study was to investigate whether heat emitted from the feet of patients with type 2 diabetes (DM) and peripheral arterial disease (PAD) differed from those with type 2 diabetes without complications (DM). Methods: A non-experimental, comparative prospective study design was employed in a tertiary referral hospital. Out...

Although high heels are known to affect the biomechanics of human movement, most notably by increasing forefoot plantar pressure, it is commonly worn due to the influence of fashion. To deal with the resulting clinical issues, some prescriptions include the use of cushioning pads to redistribute the plantar loads and increase comfort. This prelimin...

Aim Diabetic peripheral neuropathy is an important complication and contributes to the morbidity of diabetes mellitus. Evidence indicates early detection of diabetic peripheral neuropathy results in fewer foot ulcers and amputations. The aim of this study was to compare different screening modalities in the detection of diabetic peripheral neuropa...