ArticleLiterature Review

The population prevalence of foot and ankle pain in middle and old age: A systematic review

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Abstract

A systematic review and meta-analysis of population-based epidemiological studies was undertaken to determine the prevalence of foot and ankle pain in middle and old age. Searches were conducted in the following electronic databases from inception to October 2010: PubMed, EMBASE, AMED, CINAHL, Cochrane, PEDro, and SportDiscus. Full-text English language articles were included if they used population sample frames, cross-sectional design or analysis, and reported prevalence estimates for foot and/or ankle pain in adults aged 45 years and over. Thirty-four articles from 31 studies involving 75,505 participants provided 529 prevalence estimates based on different case definitions and population strata. Random-effects meta-analyses of studies with comparable case definitions provided pooled prevalence estimates, for frequent foot pain of 24% (95% confidence interval 22-25%; n=3; I(2)=46%) and for frequent ankle pain of 15% (95% confidence interval 13-16%; n=2; I(2)=0). Small sample sizes and low response rates in some studies, together with heterogeneous case definitions, limit confident conclusions on the distribution, subtypes, and impact of foot/ankle pain. Narrative synthesis of evidence from existing studies suggested preponderance in females, an age-related increase in prevalence in women but not men, that the toes/forefoot were the most common anatomical sites of pain, and that moderate disability in an aspect of daily life was reported by two-thirds of cases. This review provides estimates of the community burden of foot and ankle pain in middle and old age. By outlining the scale of this clinical problem, these findings can be used to inform health care planning and provision.

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... Although the benefits of walking are well established, the ability to walk can be restricted due to environmental, physical or psychological issues (Thomas et al., 2011;Hunter, Ball and Sarmiento, 2018;Ward et al., 2018;Salbach et al., 2019;Alshehri et al., 2021). Foot pain is a common example of such a physical issue, with a general population prevalence in the UK, USA, Europe and Australia ranging from 13 to 36% (Garrow, Silman and Macfarlane, 2004;Hill et al., 2008;Mølgaard, Lundbye-Christensen and Simonsen, 2010;Thomas et al., 2011;Gill et al., 2016;Wranker, Rennemark and Berglund, 2016;Finney et al., 2017;Gates et al., 2019;Keenan et al., 2019). ...
... Although the benefits of walking are well established, the ability to walk can be restricted due to environmental, physical or psychological issues (Thomas et al., 2011;Hunter, Ball and Sarmiento, 2018;Ward et al., 2018;Salbach et al., 2019;Alshehri et al., 2021). Foot pain is a common example of such a physical issue, with a general population prevalence in the UK, USA, Europe and Australia ranging from 13 to 36% (Garrow, Silman and Macfarlane, 2004;Hill et al., 2008;Mølgaard, Lundbye-Christensen and Simonsen, 2010;Thomas et al., 2011;Gill et al., 2016;Wranker, Rennemark and Berglund, 2016;Finney et al., 2017;Gates et al., 2019;Keenan et al., 2019). ...
... It was concluded that not only are foot problems in the over 55 age group extremely prevalent, but they also have a considerable impact on functional abilities such as walking. Although foot pain is recognised as being more common in older people (Dunn et al., 2004;Thomas et al., 2011;Gates et al., 2019), it has also been shown to be highly prevalent among younger adults (Hill et al., 2008). ...
Thesis
The purpose of real time clinical gait analysis (RTCGA) is to aid in diagnosis of musculoskeletal (MSK) conditions, determine treatment goals and evaluate treatment outcomes. Clinicians are recommended to conduct RTCGA as part of a lower limb MSK non-neurological adult patient assessment. The timely and accurate use of such a diagnostic method, with the smallest possibility of a missed diagnosis or misdiagnosis, is crucial in the treatment of any disease or disorder. Despite this, there remains little MSK RTCGA evidence to support the methods by which to do so. This PhD reflects a programme of work which was undertaken to develop a best practice RTCGA approach for adult non-neurological lower limb MSK injury. The research aim was to establish a best practice approach for RTCGA to be used as part of a clinical MSK assessment in the treatment of non-neurological lower limb symptoms in adults. This doctoral thesis programme of work employed a mixed methods approach, involving a series of deductive quantitative investigations followed by inductive qualitative investigation. Deductive quantitative investigation involved scoping of the RTCGA best practice approach via narrative literature review, a patient and public involvement and engagement (PPIE) exercise and preclinical testing. A systematic review was conducted to robustly establish available MSK RTCGA literature. Inductive, qualitative investigation involved exploration of MSK podiatrists’ views and experiences of RTCGA for an exemplar condition, posterior tibial tendon dysfunction (PTTD), using thematic analysis of semi-structured interviews. Findings supplied the foundation by which preliminary clinical recommendations for a MSK RTCGA best practice approach were created. A preliminary objective RTCGA instrument was created. Scenario testing for face validity demonstrated this preliminary RTCGA instrument would not detect kinematic changes following intervention, and an additional immediate intervention RTCGA instrument was developed. The resultant preliminary RTCGA instrument, which was then subject to preclinical testing, consisted of 2 sections, the RTCGA instrument score and the RTCGA immediate intervention score. Preclinical investigations demonstrated difficulties in the ability to test the preliminary RTCGA instrument for both reliability and validity. Literature review and searches from narrative, systematic and PPIE investigations found a lack of high-level evidence and guidance for the use of RTCGA and the development of RTCGA best practice approaches. In total, 6 substantial problems were encountered associated with the creation of an objective quantifiable instrument as a RTCGA best practice approach. These were a lack of existing RTCGA knowledge; developer bias; the necessity to include shod gait assessment; a lack of normative kinematic data; the length and complexity of the preliminary RTCGA instrument and an inability to transiently alter kinematics and obtain valid data for testing. These issues deemed the continued development of an objective quantifiable RTCGA instrument to be counterproductive. To understand the conundrum that an objective quantifiable RTCGA was not feasible yet is an approach suggested for use by clinicians (notably podiatrists) as an embedded component of their practice, the exploration of MSK clinician views and experiences of RTCGA was sought prior to attempting any further development. The resultant exploratory qualitative investigation confirmed that use of RTCGA was valued by MSK podiatrists, but that no consistent systematic approach for RTCGA was available. Based upon these findings, a set of 4 core recommendations are proposed as a preliminary best practice RTCGA approach when assessing and treating adult PTTD (the GAIT assessment). These are: Get a diagnosis (recommendation 1). RTCGA should be conducted after a provisional clinical PTTD diagnosis has been proposed. Assess walking (recommendation 2). RTCGA should be used to aid in clinical diagnosis of adult patients with PTTD. Assessment should include a) essential kinematic observations, and b) dynamic presentation of pain. Intervene and assess (recommendation 3). RTCGA should be performed after a clinical intervention, such as the fitting of foot orthoses or footwear, to observe any kinematic changes. If fitting foot orthoses, it should also be used to assess for patient perceived comfort. Teach using clinical experience (recommendation 4). RTCGA education should be addressed through an experiential approach, such as small group practical teaching and clinical mentoring. The research undertaken in this doctoral thesis programme of work is the first to apply development frameworks and methods in the attempt to establish a mechanism to record gait and gait changes within a MSK clinical setting, without the aid of computerised or video recording technology. A preliminary RTCGA best practice approach has been produced that supplies guidance for MSK podiatrists, in the form of the GAIT assessment, to aid in the clinical treatment and assessment of PTTD. However, the pathway to achieving a robust clinical practice guideline requires more work. The lack of objective kinematic data for this field was a significant barrier to investigating and improving reliability and validity of RTCGA observations. RTCGA, as an aid in the diagnosis and treatment of MSK injury, is arguably a high-level skill associated with professional specialisation. It follows, therefore, that such a skill would be supported by objectivity and standardisation of practice, yet the lack of normative data for RTCGA continues to act as a barrier to this. A new approach in which RTCGA is focussed on the patient symptoms and evidence based observation is proposed.
... In middle-aged and elderly populations, up to 20% of people reported that they had foot or ankle pain, with nearly two thirds of those reporting significant pain that limits their daily activities. 19 The prevalence of pain also tends to be higher in people who are older, and a much larger percentage of women report having foot and ankle pain than their age-matched male counterparts. 19 Researchers have theorized that the gender differences in foot and ankle pain are related to differences in women's and men's footwear, most notably that women's footwear tends to have greater heel elevation and a more narrow toe box leading to development of various orthopedic disorders. ...
... 19 The prevalence of pain also tends to be higher in people who are older, and a much larger percentage of women report having foot and ankle pain than their age-matched male counterparts. 19 Researchers have theorized that the gender differences in foot and ankle pain are related to differences in women's and men's footwear, most notably that women's footwear tends to have greater heel elevation and a more narrow toe box leading to development of various orthopedic disorders. 19 However, there has been limited focus on studying the differences between men and women regarding seeking help for their foot or ankle pain. ...
... 19 Researchers have theorized that the gender differences in foot and ankle pain are related to differences in women's and men's footwear, most notably that women's footwear tends to have greater heel elevation and a more narrow toe box leading to development of various orthopedic disorders. 19 However, there has been limited focus on studying the differences between men and women regarding seeking help for their foot or ankle pain. ...
Article
Full-text available
Background: A significant portion of the adults suffer from foot and ankle pain. The sex differences that exist throughout health care, pain management, and orthopedics may further complicate treatment strategies. The purpose of this study was to determine if there were any differences in women and men in health care seeking behavior and symptom chronicity in a West Texas orthopedic population with foot and ankle conditions. Materials and methods: Data from 137 patients were collected in a retrospective chart review. Data were analyzed to determine if there were sex differences in time to primary care provider (PCP) after ankle injury, referral time from PCP to orthopedic surgeon consult, time from orthopedic consult to surgical intervention (if applicable), and chronicity of symptoms. Results: Women had a significantly higher percentage of chronic injuries than men (30.7% vs. 10.9%), but there were no sex differences in time to PCP from the time of injury, time from PCP visit to orthopedic consult, and time from orthopedic consult to surgical intervention. There were also no differences in those same time frames when compared by chronicity of symptoms (acute injury vs. chronic injury). Finally, we did not find any differences in pain scores between sexes or chronicity of symptoms. Conclusions: This study suggests that conventional health seeking sex differences may not apply to the foot and ankle patient population in West Texas and surrounding rural areas. Continuing to examine patterns in sex differences may lead to the development of more efficient and tailored treatment approaches and better outcomes.
... As a crude estimate, Hawke and Burns (2009) suggest that at a given time point, one quarter of the Australian population experience foot pain, whilst Thomas et al. (2004) established a prevalence of 22.9% pain in the United Kingdom. The overall pooled prevalence of foot pain was documented in a meta-analysis by Thomas et al. (2011) as 24% specific to 'frequent' pain whilst others have reported foot pain prevalence rates ranging from 9.9% to 41.6% using differing definitions of foot pain (Cho et al. 2009;Badlissi et al. 2005). ...
... This brings to light a whole new meaning of pain whereby all contributory aspects of pain have been recorded by the authors. This concept could be considered as a 'global foot pain' approach as opposed to a 'foot joint pain' approach as highlighted by Garrow et al. (2000), Thomas et al. (2011) and Gay et al. (2014). Global pain is a concept briefly discussed by Leveille et al. (2008) whereby the authors collected data for both global foot pain and the specific location of pain, both captured effectively in the opinion of the authors by using the Foot Assessment Clinical Tool. ...
Thesis
Introduction The prevalence of foot osteoarthritis (OA) is less well understood than hip, knee and hand OA. The foot is undoubtedly more complex, and investigators have been challenged in defining which joints to investigate and by the need for improved methodological standardisation across studies. As such, the prevalence and natural history of osteoarthritis and the relevance of co-existing pain in the foot have not yet been widely explored. The aim of this thesis was to improve understanding of foot osteoarthritis by examining techniques used to define foot osteoarthritis and by description of the prevalence, distribution and natural history of radiographic foot osteoarthritis and co-existing foot pain in an established UK population-based cohort of women, ‘The Chingford 1000 Women Study’. Methods Study 1: The author (PMc) undertook training by an experienced radiographer in scoring foot osteoarthritis using a validated foot atlas (The La Trobe Foot Atlas). Employing archived foot radiographs (n = 20 paired feet) Chingford 1000 Women study: year 6, 1995) intra-rater reliability was established for five individual joints in both feet (percentage close agreement ranged from 47.6% to 85.7% for osteophytes and from 33.3% to 81% for joint space narrowing). Subsequently a sample of foot radiographs (n=218) that included all remaining participants in the Chingford 1000 Women Study who returned for the year ‘23’ visit (mean (SD) for age: 75.5 (5.1)) were scored. A range of prevalence estimates of osteoarthritis at the foot and individual joint level were examined that relate to discordance between different techniques of interpretation. The findings from this study supported the use of the La Trobe Foot Atlas (LFA) to identify foot osteoarthritis in existing current and historical radiographs of established large population cohorts. Study 2: A cross-sectional study design was used in which returning participants at year ‘23’ (2013-2015) from the Chingford 1000 Women study were investigated for presence of radiographic foot osteoarthritis and co-existing foot pain. Presence of radiographic foot osteoarthritis was scored according to LFA and self-reported foot pain was primarily defined and assessed using the non-side specific question “have you ever had pain in your feet which has lasted one day or longer?” Data from 332 women were included in this study. Of these 91.3% had radiographic foot osteoarthritis in any joint affecting either foot. When examining individual joints, the rank order of radiographic osteoarthritis was; 2nd cuneo-metatarsal joint (78.9%), 1st cuneo-metatarsal joint
... BMC Musculoskeletal Disorders (2022) 23:475 the patients' quality of life. Nevertheless, epidemiological studies do not differentiate whether the pain is related to the metatarsophalangeal joint itself or to other anatomical structures in the forefoot [6,9,11,33]. Propulsive metatarsalgia occurs during the push-off phase of the gait cycle. ...
... This study has some limitations. In the first place, even though the results of epidemiological studies are not homogeneous, metatarsal pain seems to be more frequent in middle-aged women [6,9,11,33]. Regarding our demographics, participants are younger, and gender distribution is nearly 50%. ...
Article
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Background Metatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. ³⁵ The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness. The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study. Methods Maximal pressure (Kpa) and pressure–time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad. Results Mean second metatarsal head maximal pressure and mean pressure–time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure–time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure–time integral reduction. Conclusions The Fixtoe Device® reduces median maximal pressure and median pressure–time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.
... A systematic review found the prevalence of frequent foot and ankle pain to be 24% and 15%, respectively, in middle and old age demographics. 6 This is especially relevant for older populations as foot pain acts as an independent risk factor for physical independence in daily activities, and other various injuries and movement impairments related to aging. 6 Overall, the population of people who require pain treatments for foot and ankle complications can be estimated to be higher with the inclusion of short-term injuries. ...
... 6 This is especially relevant for older populations as foot pain acts as an independent risk factor for physical independence in daily activities, and other various injuries and movement impairments related to aging. 6 Overall, the population of people who require pain treatments for foot and ankle complications can be estimated to be higher with the inclusion of short-term injuries. ...
Article
Objective: To assess the effect of acupuncture on foot and ankle pain intensity, functional status, quality of life, and incidence of adverse events in adults. Methods: Randomized controlled trials (RCTs) were obtained from a systematic search of 6 major English databases, and a manual search of relevant systematic reviews using Google Scholar. RCTs that compared acupuncture with various forms of sham acupuncture, nonactive and waitlist controls for pain intensity, functional status, and general quality of life were included. Study screening, data extraction, risk of bias assessment, and quality assessment were all performed independently. A narrative synthesis was performed when quantitative pooling was inappropriate. Results: Four RCTs were included, encompassing a total of 211 participants. Due to clinical heterogeneity for all outcomes, quantitative analysis was not appropriate. Our Grades of Recommendation, Assessment, Development and Evaluation rated all outcomes to have either low or very low quality of evidence. With low-quality evidence, acupuncture was shown to be efficacious for participants with plantar fasciitis for pain relief and functional status improvement at short- and intermediate-term follow-ups. Acupuncture was also shown to be efficacious for participants with Achilles tendinopathy for pain relief at short- and intermediate-term follow-ups. No adverse events were reported. Conclusion: There is some evidence to suggest acupuncture to be a safe and efficacious treatment for relieving pain and improving functional status for the foot and ankle. The results of this systematic review should be interpreted with caution due to the limited evidence. Future research should take into consideration the findings of this systematic review.
... Nevertheless, epidemiological studies do not differentiate whether the pain is related to the metatarsophalangeal joint itself or to other anatomical structures in the forefoot. 6,9,11,33 Propulsive metatarsalgia occurs during the push-off phase of the gait cycle. During this phase, ground reaction forces increase in the forefoot's region. ...
Preprint
Full-text available
Background: Metatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. 35 The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness. Methods: The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study. Maximal pressure (Kpa) and pressure-time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad. Results: Mean second metatarsal head maximal pressure and mean pressure-time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure-time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure-time integral reduction. Conclusions: The Fixtoe Device® reduces median maximal pressure and median pressure-time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.
... However, the appearance of these problems is not only concentrated in the elderly population. According to [9], around 24% of people over 45 years report frequent foot pain. Many of these disorders arise as a result of having some physical abnormality not treated efficiently, such as flat feet, which gradually affects the rest of the musculoskeletal system. ...
Article
Full-text available
Nowadays, the study of the gait by analyzing the distribution of plantar pressure is a well-established technique. The use of intelligent insoles allows real-time monitoring of the user. Thus, collecting and analyzing information is a more accurate process than consultations in so-called gait laboratories. Most of the previous published studies consider the composition and operation of these insoles based on resistive sensors. However, the use of capacitive sensors could provide better results, in terms of linear behavior under the pressure exerted. This behavior depends on the properties of the dielectric used. In this work, the design and implementation of an intelligent plantar insole composed of capacitive sensors is proposed. The dielectric used is a polydimethylsiloxane (PDMS)-based composition. The sensorized plantar insole developed achieves its purpose as a tool for collecting pressure in different areas of the sole of the foot. The fundamentals and details of the composition, manufacture, and implementation of the insole and the system used to collect data, as well as the data samples, are shown. Finally, a comparison of the behavior of both insoles, resistive and capacitive sensor-equipped, is made. The prototype presented lays the foundation for the development of a tool to support the diagnosis of gait abnormalities.
... Foot pain is a common disorder reported in 24% of adults and can be a cause of disability [1]. Among the causes of foot pain is the entrapment of tibial nerve or one of its branches a condition known as tarsal tunnel syndrome (TTS) [2]. ...
Article
Full-text available
Background Electrodiagnostic tests (EDXTs) have been considered the gold standard method for the diagnosis of tarsal tunnel syndrome (TTS); however, definitive tests has not yet been discovered. Our aim was to develop new nerve conduction provocative techniques in the double and single leg stance as well as combined ankle dorsiflexion with foot eversion accompanied by compression for the diagnosis of suspected TTS. Results Routine combined nerve conduction studies (NCSs) using medial plantar (MP) and lateral plantar (LP) nerves had a 60.9% sensitivity for the diagnosis of TTS. The diagnostic sensitivity increased when combining the three novel tests reaching 82.6% and 78.3% using either MP or LP NCSs respectively. The diagnostic sensitivity further increased to reach 100% when combining the MP and LP novel NCSs considering either the latency or amplitude. Conclusion The full diagnostic sensitivity for TTS reached 100% by using a battery of novel tests. The proposed diagnostic workup by this study recommends using these biomechanically challenging tests to complete the diagnostic battery of tests especially in symptomatic patients with negative routine tests.
... F F oot problems, accompanied by pain, are a widespread worldwide condition, affecting one in 5 people over the age of 50 (1,2). Beyond the economic burden (3), foot pain has a big impact on the functional decline of people by affecting their mobility, which is accompanied by a decrease in value systems in which they live and in relation to their goals, ex-pectations, standards, and concerns" (4), no consensus currently exists regarding the exact meaning of QoL. ...
Article
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Background: Chronic foot pain (CFP) is a widespread condition worldwide; however, few studies that relate CFP and foot health-related quality of life have been reported. Objective: The aim of this study was to describe the impact of foot health and health in general in a sample of adult people with CFP compared with a control group. Study design: This study was designed as a retrospective case-control study. Setting: Podiatric section of a care center. Methods: Two hundred adults were included in the study. Patients were divided into CFP patient (n = 100) and control groups (n = 100). All of them regularly attended a private podiatric clinic to take care of their foot health. Self-reported data and medical histories for people with and without CFP were evaluated. All findings were compared with quality of life (QoL) scores based on the Foot Health Status Questionnaire, Spanish version. Results: Adults with CFP (compared to the control group) showed reductions in QoL linked to overall health and foot health in particular and were statistically significant with respect to several domains: (1) foot pain, (2) foot function, (3) general health, and (4) physical activity. These differ-ences were evaluated with a t-test for independent samples, and statistical significance was consid-ered a P value of P < 0.05. Limitations: The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded. Conclusions: CFP patients, regardless of gender, recorded a negative influence on QoL-related foot health that seems to be linked with the presence of this chronic condition.
... The prevalence of ankle and foot problems was 186 per 10000 registered patients. These figures are much lower than suggested in other similar studies, who gave prevalence of 24% for foot problem and 15%-foot ankle problem [17]. This could be due to differences in the health care set up and the way physicians read code ankle and foot problems and many patients may not be consulting their physician due to these problems. ...
Article
Objective: To estimate the prevalence and characteristics of consultations due to ankle and foot conditions in Qatar. Methods: Data was obtained retrospectively from the computerized records in health centres of Primary Health Care Corporation from January to December 2019.The data was stratified by age, sex, nationality and different subgroups of causes. Results: There were a total 792043 consultations in phcc during the period of January to December 2019. The consultations were mostly non traumatic at 15525 (58%). Of these 26862 (3.3%) were related to ankles and foot problems, the most commonly documented code was foot pain 5960 (22.1%) followed by foot injury 3325 (12.3%). Males (54%) accounted for slightly more consultations than females 46%. Being outside normal weight range accounted for almost 40% of consultations (Obese 34.7% and underweight 25.8%). The prevalence of ankle of foot problems was 186 per 10000 registered patients. Conclusion: The burden of ankle and/or foot encounters in primary care is not insubstantial and includes all ages, gender and nationality. The authors recommend further training of practitioners in proper coding.
... En la dimensión Dolor ser mujer se revela como valor independiente para obtener puntuaciones elevadas (OR = 2,50; IC 1,52-4,19) y también lo hace la edad (OR = 1,02; IC 1,01-1,03), aunque en valores de probabilidad más discretos. La relación con la condición de sexo femenino concuerda con múltiples estudios que han detectado que ser mujer supone un factor de riesgo para manifestar sufrir dolor de pies 6,23,25,29,30 . También muestra ese efecto independiente, con puntuaciones elevadas en la dimensión Dolor, la morfología de huella plantar Arch Index bajo (OR = 2,10; IC 1,21-3,67), relación concordante con la sintomatología dolorosa descrita para la patología de pie plano. ...
Article
Abstract Objective: The aim of the study was to analyze how the medial longitudinal arch morphology and the foot position determines func- tional capacity and its relation to pain in adult population. Materials and methods: an observational cross-sectional study was carried out in an adult population of n = 423 subjects, α = 0,05; precision ± 5 % in the estimates of the variables of interest. Medial longitudinal arch morphology/height was determined obtaining nor- malized anthropometric dimensions and footprint morphology according to an arch index. Foot Posture Index-6 was used to determine foot posture. The degree of foot pain and dysfunction was obtained by using the Manchester Foot Pain and Dysfunction Questionnaire. A descriptive analysis of the sociodemographic and clinical variables of the subjects was performed. In the bivariate and multivariate logistic regression analysis, it was determined which variables were related to pain and foot function, estimating raw and adjusted values of odds ratio (OR). Results: In the function dimension, female sex (OR adjusted = 2.62 95 % IC 1.55-4.44, p < 0.001) and having at least one foot pronated or very pronated, (OR adjusted = 1.98; 95 % IC 1.17-3.37, p = 0.011), appeared as independent factors that influenced obtaining scores above the median. In the pain dimension, age (OR adjusted =1.02; 95 % IC 1.01-1.03, < 0.05), female sex (OR adjusted = 2.52, 95 % IC 1.52-4.19, p < 0.001) and presenting flat footprint morphology (OR adjusted = 2.10, 95 % IC 1.21-3.67, p < 0.05) were the significant variables to the group with scores higher than the median. Conclusions: Being a woman and having pronated positions increase the probability of higher scores when evaluating dysfunctional disabilities. In the pain dimension, the probability of obtaining higher scores increases with age, female sex and having a flat footprint morphology.
... Foot pain affects one in four, and ankle pain one in six, adults aged 45 years and over [1]. Both are associated with high burden of disease [2,3]. ...
Article
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Introduction Patients with chronic foot/ankle pain are often referred for orthopaedic assessment. Psychological vulnerabilities influence pain states (including foot and ankle), therefore this study aimed to establish the prevalence and relative importance of compromised psychological health to perceived foot/ankle pain severity in people referred to an orthopaedic foot and ankle clinic with non-urgent presentations. Methods Patients with triaged non-urgent foot/ankle referrals to the Department of Orthopaedics at Gold Coast University Hospital were recruited over a 12-month period and completed the Manchester-Oxford Foot and Ankle Questionnaire which was the primary measure. Participants also completed questionnaires assessing their anthropometric, demographic and health characteristics ( Self-Administered Comorbidity Questionnaire ) as well as measures of health-related quality of life ( EuroQol-5-Dimensions-5-Level Questionnaire and EQ Visual Analogue Scale ) and psychological health ( Center for Epidemiological Studies-Depression scale , Pain Catastrophizing Scale and Central Sensitization Inventory ) . Descriptive statistics were used to summarise participant characteristics and a hierarchical multiple linear regression was employed to establish the extent to which psychological variables explain additional variance in foot/ankle pain severity beyond the effects of participant characteristics (age, sex, body mass index (BMI)). Results One hundred and seventy-two adults were recruited ((64.0% female), median (IQR) age 60.9 (17.7) years and BMI 27.6 (7.5) kg/m ² ). Specific psychological comorbidities were prevalent including depressive symptoms (48%), central sensitisation (38%) and pain catastrophising (24%). Age, sex and BMI accounted for 11.7% of the variance in MOXFQ-index and psychological variables accounted for an additional 28.2%. Pain catastrophising was the most significant independent predictor of foot/ankle pain severity (accounting for 14.4% of variance), followed by BMI (10.7%) and depressive symptoms (2.3%). Conclusions This study demonstrated that specific psychological comorbidities and increased BMI are common in this cohort and that these factors are associated with the symptoms for which patients are seeking orthopaedic assessment. This knowledge should prompt clinicians to routinely consider the psychosocial components of patient presentations and develop non-operative and pre-operative treatment strategies which consider these factors with the goal of improving overall patient outcomes.
... A total of 40 protheses could not be included in the study due to a lack of the minimum FU of 2 years, which represents another limitation, as does the unequal distribution of the number of patients between the two study groups. One possible explanation for the unequal distribution might be the higher prevalence of OA in older patients in general [43,44]. Furthermore, it was not possible to retrospectively determine the duration of each surgery. ...
Article
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Background and Objectives: Due to inferior survival rates compared to hip and knee arthroplasty, total ankle arthroplasty (TAA) was previously mainly recommended for older and less active patients. However, given the encouraging survival rates and clinical outcomes of modern generations of TAA, some authors have also advocated TAA in young patients. Thus, the aim of this study was to evaluate age related reoperation, revision and survival rates of third-generation mobile-bearing TAAs. Materials and Methods: In this retrospective study, 224 consecutive TAA patients with a minimum follow up (FU) of 2 years were analyzed. Patients were retrospectively assigned to two study groups (Group A: age < 50 years; Group B: age ≥ 50 years). Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. Results: After a mean FU of 7.1 ± 3.2 years, the reoperation rate (Group A: 22.2%; Group B: 5.3%; p = 0.003) and revision rate (Group A: 36.1%; Group B: 13.8%; p = 0.003) were higher within Group A. An age of under 50 years at time of surgery was associated with higher reoperation (odds ratio (OR): 6.54 (95% CI: 1.96–21.8); p = 0.002) and revision rates (OR: 3.13 (95% CI: 1.22–8.04); p = 0.018). Overall, lower patient age was associated with higher reoperation (p = 0.009) and revision rates (p = 0.001). Conclusions: The ideal indication for TAA remains controversial, especially regarding patient age. The findings of this study show high reoperation and revision rates in patients aged under 50 years at time of surgery. Therefore, the outcomes of this study suggest that the indication for TAA in young patients should be considered very carefully and that the association between low patient age and high reoperation rate should be disclosed to all eligible patients.
... Concerning the gender, there is evidence to suggest that women are more likely to have foot pain than men, associated with wearing unhealthy footwear. In relation to foot pain, our results reported that the foot pain outcome was greater in the general population than minority ethnic group(Thomas et al., 2011). Pain could be caused by wearing inappropriate footwear. ...
Article
Objective To analyze the impact of the foot health and health behavior and the characteristics of outdoor footwear among minority ethnic groups. Design and measures A cross-sectional study design using the Foot Health Status Questionnaire: foot pain, foot function, shoe, general foot health, general health, physical activity, social capacity, and vigor. Outcomes included the self-reported type of outdoor footwear and clinical characteristics by sex were collected in 2019–2020. Sample A total of 78 Roma participants self-identified as members of this ethnic minority and 72 participants non-Roma were assessed (n = 150). Results The lower score values was recorded in the footwear and general foot health domains in Roma population. General population obtained higher scores in general health domains. The most common outdoor footwear types were running shoes and walking shoes in non-Roma population, versus flip flops and slippers in Roma population. Clinical characteristics did not show any statistically significant differences (p < .05). Conclusion Roma people wear flip flops and slippers and non-Roma people running shoes and walking shoes. These findings reveal cultural differences that make it easier for the Roma population to experience a greater burden of foot health problems. General foot health and foot pain dimensions show statistically significant differences among ethnicity.
... Foot and ankle pain is a common complaint in clinical contexts with a reported prevalence of 25% and 15% in individuals over the age of 45, respectively (Thomas et al., 2011). For those with foot pain over the age of 50, up to three-quarter report disability related to the foot on most days (Roddy et al., 2009). ...
Article
Background The supination resistance test (SRT) is a kinetic test used in clinical and research contexts to estimate the amount of force required to supinate the foot. Previous studies either used a manual, less reliable version of this test or a more reliable instrumented version, but with devices inconvenient for clinical use. The clinically available Keystone device has been developed for the SRT, and could be better suited for clinical purposes. The objective of this study is to determine the intrarater and interrater reliability of the Keystone device for the SRT. Method Thirty young adults underwent two prospective experimental sessions, 1 week apart, during which SRT measures with the Keystone device were registered. Intrarater and interrater reliability were calculated using intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable difference (MDD) and limits of agreements (LoA). Results The intrarater reliability of the SRT was good (ICC = 0.86, p < 0.001). The SEM, MDD and 95% LoA were 7.3, 20.4 and −31.6–14.3 N, respectively. The interrater reliability of the SRT was good (ICC = 0.76, p < 0.001). The SEM, MDD and 95% LoA were 9.0, 24.9 and −36.6–24.9 N, respectively. Conclusion The Keystone device is a reliable tool that can be used in clinical and research contexts. Prospective studies aiming to determine if SRT measures are predictors of musculoskeletal injuries or if they can predict the effects of external supports on the biomechanics of the foot and ankle are warranted.
... A high-velocity low-amplitude thrust joint manipulation is an intervention that has a growing body of evidence supporting its use for the management of neck and back pain [1-4]; however, evidence supporting joint manipulation as an intervention for lower extremity conditions is much less robust [5]. Foot pain is common [6,7], with the most encountered diagnoses being plantar fasciitis [8], foot and ankle sprains [9], and tendinopathies [10]. A less commonly encountered diagnosis is cuboid syndrome [11]. ...
... Nevertheless, epidemiological studies do not differentiate whether the pain is related to the metatarsophalangeal joint itself or to other anatomical structures in the forefoot. 6,9,11,33 Propulsive metatarsalgia occurs during the push-off phase of the gait cycle. During this phase, ground reaction forces increase in the forefoot's region. ...
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Background: Metatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. 35 The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness. Methods: The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study. Maximal pressure (Kpa) and pressure-time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad. Results: Mean second metatarsal head maximal pressure and mean pressure-time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure-time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure-time integral reduction. Conclusions: The Fixtoe Device® reduces median maximal pressure and median pressure-time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.
... Moreover, it is not only low back pain that is concerned: heavy lifting and prolonged standing bring about neck pain, lower extremity pain and oedema, upper back pain, shoulder pain, and wrist/hand pain. The prevalence of disabling foot and ankle pain among the general population is quite high, at up to 30%, and it is also common in younger people (8). Musculoskeletal pain can cause loss of motivation to work and is a major cause of sick leave and premature retirement among nursing personnel (9). ...
Article
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Aim. To develop and test the effectiveness of an E-learning program for promoting physical activity (PA) and wellness among nurses. Background. Restrictions during the coronavirus (COVID-19) pandemic drastically changed many people's lives. Maintaining a healthy lifestyle is an everyday challenge faced by the general population. Nurses are one of the health care professionals who are typically well-educated in taking care of patients. There are studies that show that night shifts, extended shifts, and obesity have a correlation with the prevalence of acute low back pain among female nurses. PA is the key factor in the prevention and treatment of many chronic diseases, resulting in an improvement in the quality of life. The impact of social media and technology on our lives is undeniable in the modern era. Design. This study will be a single-Centre, single-blind, randomized controlled trial executed on an E-learning platform to provide the control and intervention groups with a distance learning program. Participants will be randomly assigned to either the control or intervention group. Participants in the control group will only sign up for module 1 of the PA modules, which only comprises information on PA and health promotion. On the other hand, the participants in the intervention group are expected to carry out 3 modules of exercises at home three days a week for a total duration of 8 weeks. The exercises will be performed at moderate intensity (5–6 on the Borg CR10 Scale). Ethical issues. This trial will comply with the declaration of Helsinki 1975, as revised in 2000. Informed written consent will be obtained from the participants. The Sapienza University of Rome, institutional ethics committee and review board approval will be requested for this study. Conclusion. Establishing an online PA program with good quality, such as a high level of convenience in access and use, simplified, easy to practice, and made available on social media, can minimize the difficulties faced previously in the implementation of an online PA program for nurses, and may enhance the health and wellbeing of many nurses in healthcare institutions.
... lantar Fasciitis (PF) is an overuse syndrome as it develops over time and a common condition affecting the adult population [1][2][3]. PF affects approximately 10% of the world's general population [4,5]. It is most frequently seen both in non-athletic and athletic communities [6][7][8]. ...
Article
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Introduction: Plantar Fasciitis (PF) is an overuse syndrome as it develops over time. It is most frequently seen in both the non-athletic and athletic populations. PF is a multifactorial and self-limiting disorder that several factors are involved in its onset. Many well-established treatments are available for plantar heel pain. The purpose of this review is to determine the effectiveness of dry needling for the management of PF. Materials and Methods: This article is a review study, in which we present the studies that compare dry needling with other treatments for the management of plantar heel pain. We included all of the studies on patients with plantar heel pain and plantar fasciitis that investigated the effects of dry needling. Finally, seven articles were included in this review. The study designs were randomized controlled, quasi-experimental, and case-control. The Physiotherapy Evidence-based Database (PED) scale was used to measure the methodological quality of the studies. Results: The PEDro scoring of the articles ranged between 2.10-7.10. The results of this review show that dry needling may be useful in improving the pain of individuals with plantar heel pain and plantar fasciitis. Conclusion: Further high-quality research studies are needed to determine the effectiveness of dry needling in the management of plantar heel pain. Because a variety of protocol treatments of dry needling were used in the studies, we cannot recommend dry needling schedule prescriptions for the management of individuals with plantar heel pain and plantar fasciitis.
... Most of the older people with RA (70%) reported having lower extremity pain. The rate of foot pain was much higher compared to the general population (Thomas et al., 2011), but rather similar to adults aged 50 years and older (Menz, 2016;Roddy, 2011). The high prevalence of pain in this sample could be explained by RAspecific factors. ...
Article
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Background Foot and ankle problems are especially common in patients with RA, causing significant disability and limitation in daily activities. Previous studies have mainly focussed on foot problems in the adult population whilst the evidence of foot health in the older population is scarce. Objectives The aim of the study was to analyse self-assessed foot health and associated factors in older people with rheumatoid arthritis (RA). Methods The study applied a descriptive cross-sectional survey design and recruited older people with RA from the member register of one patient association. We collected the data in January 2019 with the Self-administered Foot Health Assessment Instrument, and sociodemographic and foot-related background questions and analysed the data with descriptive and inferential statistics. Results Older people with RA had many self-reported foot problems. The most common problems were foot pain, dry skin and thickened toenails. In addition, structural deformities of the foot were prevalent. The level of foot health associated with the amount of daily walking or standing, and using walking or running shoes outdoors. Individuals who had consulted a physician due to their foot problems had more structural deformities in the foot. Foot problems limited their ability to perform daily activities. Conclusions This study demonstrates that older people with RA not only live with a long-term health condition, but they also live with complex foot problems. Older people with RA need healthcare services due to their foot problems. There is a need to develop and implement care practices to alleviate foot pain and support and promote foot health and functional ability in older people with RA. Implication for practice Understanding the nature and consequences of foot problems in older people with RA allows healthcare professionals to perform more accurate clinical foot evaluations and develop effective interventions to prevent further foot problems.
... 10 Plantar fasciitis is estimated to account for 11 to 15 % of all foot symptoms requiring professional care among adults. 12 The Chief initial complaint is typically a sharp pain in inner aspect of Heel & Arch of Foot with the first long period of non weight bearing usually after walking approximately Ten to Twelve steps the fascia becomes stretched & pain gradually diminished. 10 In Plantar fasciitis Pain may be due to one of the following mechanisms: irritation of pain fibers by repeated trauma or chronic pressure from a thickened plantar fascia. ...
Article
Background: Plantar Fasciitis is an Inflammation of Plantar Fascia; initial complaint is typically sharp pain in inner aspect of Heel. Purposes: To compare the effect of MFR of plantar fascia & stretching of posterior muscles of lower limb with ultrasound in case of plantar fasciitis to relieve pain & improve functional ability of foot. Study design: Comparative Study. Methods: The study was performed on 30 Patients with Plantar Fasciitis; Subjects included in the study were based on the diagnosis done by orthopedic doctor, age between 20-55 years, having Pain in the plantar aspect of the heel on the first step in the morning, and Pain Intensity score NPRS Score > 4. Subjects with any previous history of steroid injection for plantar fascia were excluded. All subjects were randomly allocated into 2 Groups. Group A (n=15) received MFR with Ultra Sound & Group B (n=15) received Stretching of posterior muscles of lower limb with Ultra Sound. All Participants were assessed using following Outcome Measures in term of NPRS and FFI Pre & Post intervention Sessions. Results: All data statistically analyzed using paired't' test and independent't' test. Analysis of Group A& Group B showed significant difference but the Results showed that the group B more effective compared to Group A for reducing Pain and improve Functional ability of foot for outcome measures NPRS &FFI (P < 0.05). Conclusion: This Study Concludes that Stretching Technique more effective as compared to Myofascial Release with Ultra Sound in case of Plantar Fasciitis.
... Düşmenin ve düşme endişesinin birçok farklı nedeni olmakla birlikte son yıllarda ayak ağrısının düşme ile ilişkisinin incelendiği çalışmalar dikkat çekmektedir. Ağrının eşlik ettiği ayak problemlerinin yaşlıların yaklaşık %24'ünde görüldüğü (6) ve denge bozukluklarına neden olarak düşme riskini arttığı bildirilmiştir (7)(8)(9). Bu durum 65 yaş üstü bireylerin %28-35'inin, 75 yaş üstü bireylerin ise %32-42'sinin yılda en az bir kez düşme deneyimi (10) ve toplumda yaşayan yaşlıların yaklaşık %50'sinin de düşme endişesi yaşadığı (11,12) göz önüne alındığında önemli bir problemdir. ...
Article
ÖZET Amaç: Bu çalışmanın amacı toplumda yaşayan yaşlılarda ayak fonksiyonunun denge, düşme ve düşme endişesi ile ilişkisini belirlemektir. Gereç ve Yöntem: Denizli merkezde yaşayan 47 yaşlı (13 kadın, 34 erkek) çalışmaya dahil edildi. Ayak fonksiyonları Ayak Fonksiyon İndeksiyle (FFI), düşme endişesi Uluslararası Düşme Etkinliği Ölçeğiyle (FES-I), dinamik denge ve düşme riski Süreli Kalk-Yürü Testiyle (SKYT) değerlendirildi. Ayrıca yaşlıların son bir yıldaki düşme deneyimleri de sorgulandı. Bulgular: Çalışmaya katılan yaşlıların yaş ortalaması 75.34±7.81 yıldı. FFI skoruna göre yaşlılarda hafif derecede ayak ağrısı (21.19±19.87) ve aktivite kısıtlılığı (15.34±12.20), orta derecede yetersizlik (32.72±26.00) bulundu. Yaşlıların %76.7'sinin düşme endişesi yaşadığı, %57.4'ünün düşme riski taşıdığı saptandı. FES-I ile FFI'nin ağrı (r=0.538 p=0.000), yetersizlik (r=0.417 p=0.004) ve aktivite kısıtlılığı (r=0.532 p=0.000) alt grupları arasında pozitif yönde orta düzeyde anlamlı ilişki saptandı. SKYT ile FFI'nin ağrı (r=0.367 p=0.011) ve yetersizlik (r=0.352 p=0.015) alt grupları arasında pozitif yönde hafif düzeyde anlamlı ilişki gözlenirken aktivite kısıtlılığı (r=0.602 p=0.000) alt grubu ile yüksek düzeyde anlamlı ilişki bulundu. Sonuç: Çalışmamız sonucunda ayak ağrısının ve ayak problemlerinden kaynaklanan günlük yaşam aktivitelerindeki yetersizlik ve aktivite kısıtlılığının denge kaybını, düşme riski ve endişesini arttırabileceği saptandı. Ayak problemleri nedeniyle fiziksel aktivite kısıtlaması veya fiziksel aktiviteden kaçınma kısa vadede yaşlıyı düşmelere karşı korusa da, uzun vadede yaşlının fiziksel ve zihinsel sağlığına zarar vermekte, sosyal katılımını kısıtlanmakta, yaşam kalitesini azaltmakta ve gelecekteki düşme riskini arttırmaktadır. Bu sebeple yaşlıların ayak sağlığıyla ilgili farkındalıklarının artırılmasının, ayak problemlerinin belirlenip gerekli önlemlerin alınmasının tüm bu risklerin ortadan kaldırılması açısından önemli olduğunu düşünmekteyiz. Anahtar Kelimeler: Ayak ağrısı, ayak fonksiyonu, düşme, düşme endişesi, yaşlılık Balance, Falls, Fear of Falling, and Foot Function in Elderly People in Community-Dwelling Older Adults ABSTRACT Purpose: The aim of this study was to determine whether foot function is associated with balance, falls, fear of falls in community-dwelling older adults. Materials and Methods: A total of 47 older adults (13 women, 34 men) residing in Denizli were included. Foot functions, fear of falling, dynamic balance and fall risk were evaluated by the Foot Function Index (FFI), Falls Efficacy Scale International (FES-I), Timed Up and Go test (TUG), respectively. The number of fall experience in the previous year was questioned. Results: The mean age was 75.34±7.81 years. According to the FFI score, mild foot pain (21.19±19.87) and activity limitation (15.34±12.20), moderate disability (32.72±26.00) were found. 76.7% of the participants had fear of falling and 57.4% had a risk of falling. There was a moderate positive correlation between FES-I and FFI-pain (r=0.538,p=0.000), FFI-disability (r=0.417,p=0.004), FFI-activity limitation (r=0.532,p=0.000). There was a weak positive correlation between TUG and FFI-pain (r=0.367,p=0.011) and FFI-disability (r=0.352,p=0.015), while a strong positive correlation in FFI-activity limitation (r=0.602,p=0.000). Conclusion: As a result of our study, activity limitation and disability of daily living activities due to foot pain and foot problems may increase the loss of balance, fall risk and fear of falling. Although in the short term, restriction or avoidance of physical activity due to foot problems protects the elderly against falls, in the long term it deteriorates the physical and mental health, restricts social participation, reduces the quality of life, increases the risk of future falls. Therefore, we think that it is important to increase the awareness of the elderly about foot health, to identify foot problems and to take necessary precautions in order to eliminate all these risks. Keywords: Foot pain, foot function, fall, fear of falling, elderly
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Background: Baggers play a significant role in the customer service of supermarket stores. Objective: The purpose of this study was to determine the effects of biomechanical risk factors on musculoskeletal disorders (MSD) experienced by baggers in the supermarket industry. Methods: Forty baggers employed among five supermarket stores in the National Capital Region in the Philippines participated in the study. To examine the biomechanical risk factors of the baggers, this study used an observational approach as well as standard ergonomic tools like REBA and NIOSH. In addition, musculoskeletal discomfort was subjectively rated using the standardized Cornell Musculoskeletal Disorder Questionnaire at the end of the work shift. Furthermore, correlation and stepwise regression analysis were utilized to determine the association between biomechanical risk factors and MSD. Results: Approximately 76% of study participants reported work-related MSD. The highest prevalence was in the foot area, followed by upper back, shoulder, lower leg, lower back, neck, and upper arm. Pearson correlation analysis had found a significant association between MSD and biomechanical risk factors. The highest correlation was observed between MSD and postural risk index (R2 = 0.863, p < 0.001), followed by weight lifted (R2 = 0.836, p < 0.001), task duration (R2 = 0.816, p < 0.001), task frequency (R2 = 0.756, p < 0.001), and lifting index (R2 = 0.661, p < 0.001). Furthermore, stepwise regression analysis revealed that the postural risk index (REBA) had the highest coefficient value (β=16.99), indicating the strongest positive effect to MSD. Conclusion: This present study revealed that grocery baggers are frequently exposed to risk factors such as awkward posture, lifting heavy loads, extended task durations, and prolonged postures during repetitive tasks increased their risk of developing MSDs. Hence, preventive measures are suggested to minimize the risk of MSD, such as the implementation of intervention through ergonomic solutions like awareness and training on safe lifting practices, adjustment of workstations to fit the stature of workers, introducing rest breaks in between work shifts, use of floor mats, and use of compression stockings in conjunction with safety shoes.
Article
Background : Ankle osteoarthritis(OA) has detrimental effects on physical health and has a relatively early disease onset compared to OA in other joints. However, the prevalence of radiographic ankle OA in different subgroups of patients referred for ankle radiography remains unknown. Therefore, we aimed to determine the prevalence of radiographic talocrural, subtalar and talonavicular OA(Kellgren-Lawrence scale ≥2) in a population referred for ankle radiography. Moreover, we aimed to identify differences in prevalence between specific subgroups of patients i.e. Body Mass Index (BMI), sex, age and reason for referral. Methods : A cross-sectional study was conducted at a radiology department serving primary and secondary care. Patients completed a questionnaire before radiography. Features of radiographic ankle OA were assessed for subgroups of patients, including; BMI, sex, age and reason for referral (chronic vs (sub)acute complaints). To examine the difference in (features of) radiographic OA for subgroups, multinomial and logistic regression were used to calculate Odds Ratios (ORs), with adjustment for age, sex and BMI. Results : Data from 893 patients that visited the radiology department across 16 months in 2017 or 2018 were included for analysis. Prevalence of radiographic ankle OA was 9.2%, 0.4% and 7.0%, for the talocrural, subtalar and talonavicular joint, respectively. Obesity was associated with radiographic talonavicular OA (adjusted OR 2.16, 95%CI:1.09; 5.26). Radiographic talocrural and talonavicular OA were both positively associated with male sex [(adjusted OR 4.64, 95%CI:276; 7.81) and (adjusted OR 1.95, 95%CI:1.13; 3.35), respectively]. Conclusion : Radiographic ankle OA was more common in men and obese patients that were referred to radiology.
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Objective: To explore consultation patterns, management practices, and costs of foot, ankle, and leg problems in Australian primary care. Study design: We analyzed data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS terminology. Data were summarized using descriptive statistics examining general practitioner (GP) and patient characteristics associated with a foot, ankle, or leg problem being managed. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule and for nonprescribed medications, large banner discount pharmacy prices were used. Results: GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle, or leg problems were managed at a rate of 3.24 (95% confidence intervals [CIs] 3.21-3.28) per 100 encounters. The management rate of foot, ankle, or leg problems was higher for certain patient characteristics (older, having a health care card, socioeconomically disadvantaged, non-Indigenous, and being English speaking) and GP characteristics (male sex, older age, and Australian graduate). The most frequently used management practice was the use of medications. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m. Conclusions: Foot, ankle, and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.
Chapter
Pain management is an essential part of clinical practice for all healthcare providers from trainees, physician assistants and nurse practitioners through to practising physicians. Problem-Based Pain Management is a collaboration between experts in anesthesiology, geriatric medicine, neurology, psychiatry and rehabilitation which presents a multidisciplinary management strategy. Over 60 chapters follow a standard, easy-to-read, quick access format on: clinical presentation, signs and symptoms, lab tests, imaging studies, differential diagnosis, pharmacotherapy, non-pharmacologic approach, interventional procedure, follow-up and prognosis. The broad spectrum of topics include headache, neck and back pain, bursitis, phantom limb pain, sickle cell disease and palliative care. Unlike other large, cumbersome texts currently available, this book serves as a quick, concise and pertinent reference in the diagnosis and management of common pain syndromes.
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This study aimed to compare health-related quality of life (HRQoL) in people with and without plantar heel pain (PHP). This was a cross-sectional observational study that compared 50 adult participants with PHP to 25 participants without PHP who were matched for age, sex and body mass index (BMI). HRQoL measures included a generic measure, the Short Form 36 version 2 (SF-36v2), and foot-specific measures, including 100 mm visual analogue scales (VASs) for pain, the Foot Health Status Questionnaire (FHSQ), and the Foot Function Index-Revised (FFI-R). Comparisons in HRQoL between the two groups were conducted using linear regression, with additional adjustment for the comorbidity, osteoarthritis, which was found to be substantially different between the two groups. For generic HRQoL, participants with PHP scored worse in the SF-36v2 physical component summary score (p < 0.001, large effect size), but there was no difference in the mental component summary score (p = 0.690, very small effect size). Specifically, physical function (p < 0.001, very large effect size), role physical (p < 0.001, large effect size) and bodily pain (p < 0.001, large effect size) in the physical component section were worse in those with PHP. For foot-specific HRQoL, participants with PHP also scored worse in the VASs, the FHSQ and the FFI-R (p ≤ 0.005, huge effect sizes for all domains, except FHSQ footwear, which was large effect size, and FFR-R stiffness, activity limitation, and social issues, which were very large effect sizes). After accounting for age, sex, BMI and osteoarthritis, adults with PHP have poorer generic and foot-specific HRQoL.
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Background: Foot ankle, and leg problems are highly prevalent in the general population. The objective of this study was to explore consultation patterns, management practices and costs of foot, ankle, and leg problems in Australian primary care. Methods: We analysed encounter data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016 inclusive. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS clinical terminology. Data were summarised using descriptive statistics and 95% confidence intervals around point estimates, and multivariate logistic regression was used to determine general practitioner (GP) and patient characteristics independently associated with a foot, ankle or leg problem being managed at an encounter. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule, and for non-prescribed medications, large banner discount pharmacy prices were used. Results: GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle or leg problems were managed at a rate of 3.24 (95% CIs 3.21 to 3.28) per 100 encounters. The management rate per head of population increased by 34% between 2000 and 2016. Management of a foot, ankle or leg problem was independently associated with patient characteristics (increased age, having a health care card, and being English-speaking) and GP characteristics (male sex, younger age, and Australian graduate). The most frequently used management practice was the use of medications, followed by procedures/physical medicine and imaging. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m. Of this total cost, MBS items comprised $139m, followed by imaging (A$69m), medications (A$29m) and pathology (A$18m). Conclusions: Foot, ankle and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.
Chapter
This eighth edition of Dr Reichel's formative text remains the go-to guide for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Fully updated and revised, it provides a practical guide for all health specialists, emphasizing the clinical management of the elderly patient with simple to complex problems. Featuring four new chapters and the incorporation of geriatric emergency medicine into chapters. The book begins with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign. A must-read for all practitioners seeking practical and relevant information in a comprehensive format.
Article
Background Population-based register data could be used to improve our knowledge of patients surgically treated for foot and ankle disorders. The quality register Swefoot was recently created to collect surgical and patient-reported data of foot and ankle surgery. This manuscript aims to describe the development and current use of the register. Methods The development of Swefoot started in 2014 and currently, data on 16 different diagnoses are collected in 49 units performing foot and ankle surgery. Registrations are performed by the surgeon and the patient. Results Between 2014-2020 approximately 20 000 surgical procedures have been registered. 75.1% of the registered patients were women, 9.3% were smokers, 9.3% had a concomitant rheumatoid disease, and 18.4% a BMI larger than 30 kg/m². Conclusions The Swefoot is a unique national register for foot and ankle surgery. It is by now possible to present demographic, surgical, and outcome parameters based on Swefoot.
Article
Background: Activity and footwear may be associated with plantar heel pain (PHP), however both factors have rarely been investigated. The aim of this study was to investigate activity and footwear characteristics in PHP while controlling for important confounders. Method: This cross-sectional observational study compared 50 participants with PHP to 25 participants without PHP who were matched for age, sex and body mass index. Activity was measured using the Stanford Activity Questionnaire, as well as the number of hours per day participants stood for, and whether they stood on hard floors. Footwear characteristics were measured using the footwear domain of the Foot Health Status Questionnaire (FHSQ), as well as the style of shoe, heel height, and the Shore A hardness value of the heel of the shoe most used. Results: Participants with PHP stood for more than twice as long as participants without PHP (mean difference 3.4 hours, p < 0.001, large effect size). Participants with PHP also reported greater difficulty accessing suitable footwear (FHSQ footwear domain mean difference (MD) 22 points, p = 0.002, large effect size (ES), and they wore harder-heeled shoes (Shore A MD 6.9 units, p = 0.019, medium ES). There were no significant differences for physical activity, whether they stood on hard floors, the style of shoe they wore, or heel height. Conclusions: Compared to people without PHP, people with PHP stand for more than twice the amount of time each day, have substantial difficulties accessing suitable footwear, and the primary shoes they wear are harder under the heel.
Chapter
This chapter covered both tibiotalar joint and subtalar joint. The pertinent anatomy, sono-anatomy, and ultrasound-guided techniques will be discussed.
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Background Foot disorders affect up to one quarter of the adult population. Plantar fasciopathy is a common cause of foot pain associated with decreased activity level and quality of life. Patient-reported outcome measures are important in assessing the burden of a condition as well as in research on the effects of interventions. The Foot Function Index revised short form (FFI-RS) is a region specific questionnaire frequently used in research. This study aimed to cross-culturally adapt the FFI-RS into Norwegian and to test its psychometric properties. Methods The FFI-RS was translated into Norwegian (FFI-RSN) following international guidelines. 139 patients with foot disorders (88% with plantar fasciopathy) were included at baseline to measure internal consistency, explorative factor analysis, construct validity and floor and ceiling effects. 54 patients were included after 1 week for test-retest reliability and smallest detectable change analyses. 100 patients were included for responsiveness and minimal important change at 3 months. Results Cronbach’s alpha for internal consistency was 0.97 and factor analysis supported the use of the total score of the FFI-RSN. Two out of three predefined hypotheses were confirmed by assessing the construct validity with Spearman’s correlation coefficient. Quadratic weighted Kappa for test-retest reliability showed 0.91 (95% CI 0.86–0.96) and the smallest detectable change was 6.5%. The minimal important change was 8.4% and the area under the receiver operating characteristic curve for responsiveness was 0.78 (95% CI 0.69–0.87). We found no floor or ceiling effects on the total score of the FFI-RSN. Conclusions The present study showed excellent reliability of the FFI-RSN and supports the use of the total score of the questionnaire. Furthermore, we found the FFI-RSN to have acceptable responsiveness in relation to change in general health. Smallest detectable change, minimal important change and responsiveness were presented as novel results of the total score of the FFI-RS. FFI-RSN can be used to evaluate global foot health in clinical or research settings with Norwegian patients suffering from plantar fasciopathy. Trial registration Clinical Trials.gov NCT04207164. Initial release 01.11.19.
Article
Modern anesthetic management for foot and ankle surgery includes a variety of anesthesia techniques including general anesthesia, neuraxial anesthesia, or MAC in combination with peripheral nerve blocks and/or multimodal analgesic agents. The choice of techniques should be tailored to the nature of the procedure, patient comorbidities, anesthesiologist skill level, intensity of anticipated postoperative pain, and surgeon preference.
Article
Background: The evaluation of musculoskeletal pain in podiatric medical practice is mainly based on anamnesis and manual examination. However, when manual palpation is performed, the digital pressure necessary to adequately explore the different structures of the foot is unknown. We evaluated the pressure pain threshold in forefoot structures to determine the intensity and duration of the stimulus as clinically relevant and representative. Methods: In a transversal analytical study of 15 healthy individuals, 16 forefoot points were explored with a handheld pressure palpometer calibrated to exert maximum pressing force of 1.0 or 2.0 kilogram-force (kgf) applied during 5 or 10 sec. The combinations of the different pressures and intervals were selected randomly. Participants had to self-rate the pressure pain sensitivity of each stimuli on a 100-mm horizontal line (0–100 numeric rating scale), setting the pain threshold to 50 (100 being pain as bad as it could be). Likewise, aftersensation and referred pain patterns were recorded. Results: All participants indicated painful stimuli at some of the 16 forefoot points studied in the experimental protocol when pressure was applied with the 2.0-kgf palpometer; 53.3% showed evidence of pain at any forefoot point when the 1.0-kgf palpometer was used. The odds of evoking a painful sensation are 9.8 times higher when using a 2.0-kgf palpometer versus a 1.0-kgf palpometer. In addition, referred sensations were observed with a significantly higher frequency when applying the 2.0-kgf palpometer. Conclusions: Bone and soft structures show differences in pressure sensitivity, increasing significantly when applying higher pressure force. Soft structures, specifically intermetatarsal spaces, showed the lowest pain pressure thresholds. More research is needed to better understand pressure pain response.
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Background: Physical activity helps weight maintenance and has health benefits, but adults with obesity report activity barriers. Although psychological concerns are important barriers, interventions underpinned by psychological theory have had limited success. This may be because of the limited focus on fear, particularly in younger adults. Aim: To explore the emotion of fear as a barrier to physical activity in younger adults (aged 18-45 years) with obesity Method: This PhD consisted of three phases: i) a scoping literature review on activity related fears; ii) a semi-structured interview study in 10 younger adults to explore activity-related fear experiences and iii) a cross-sectional survey to develop and validate a new tool on pain-related fear for younger adults and explore differences across body mass index groups. Results: The scoping review identified 38 relevant papers. It confirmed fear as an important physical activity barrier but with limited information on younger adults with obesity. The semi-structured interviews suggested fear was an important activity related barrier in this group, particularly pain-related fear. These findings were used to develop a conceptual map of pain-related fear. Current measures of pain-related fear (PASS-20, PDI and NRS) only mapped onto the conceptual map when combined, but with considerable overlap. In total, 236 participants completed the three instruments. Factor analysis of their item scores resulted in a four-factor model with 12 items, with good construct and criterion validity. Participant scores on this new instrument confirmed those classified as obese had significantly higher pain-related fears compared to healthy weight adults (mean scores 29.8 vs 22.3; P= 0.000). Conclusion: Fear, particularly pain-related fear, may be an important barrier to activity in younger adults with obesity. A conceptually underpinned new instrument, named the Pain-Related Fear Scale, will allow large-scale investigation of pain-related fear, and inform interventions to increase activity, within this under-researched group.
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This chapter provides an overview of the epidemiology and management of common foot problems in older people and updates recently published reviews on this topic. Foot problems have a significant detrimental impact on mobility and health status in older people and a sizeable subsequent burden on the healthcare system. The management of foot problems in older people varies considerably between countries due to differences in the organisational structure of healthcare systems and scope of practice of various health professions. In the foot, xerosis typically presents as erythematous dry scaling and fissuring of the skin on the dorsum of the foot and between the toes. Foot ulcers have a characteristic clinical presentation depending on their underlying cause. Non‐surgical management of hallux valgus may involve footwear advice or modification, foot orthoses, night splints, physical therapy, and foot and ankle exercises. Footwear advice is an essential component of the effective management of foot problems in older people.
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Background Patients with lower extremity problems (LEP) commonly experience functional loss, pain, decreased range of motion, inadequacy in daily living activities, and structural change in radiographic evaluations. However, the traditional patient-reported outcome measurement which focused on symptoms, had a limited scope of applicability. This study aimed to validate the psychometric properties of the Korean version of PROMIS-29 Profile v2.1 (K-PROMIS-29 V2.1), a multi-dimensional measure for assessing generic profile health-related quality-of-life (HRQoL) in a sample of patients with lower extremity problems (LEP). Methods Participants were recruited from the orthopedic outpatient clinics at the Samsung Medical Center in Seoul, South Korea from September to October 2018. Participants completed a survey questionnaire that included the K-PROMIS-29 V2.1 and the SF-36v2. Principal component analysis (PCA) and confirmatory factor analysis (CFA) and Pearson’s correlations were used to evaluate the reliability and validity of the K-PROMIS-29 V2.1. Results A total of 299 participants were enrolled in the study and 258 (86%) completed the study questionnaire. The mean age (SD) of the participants was 56.6 (14.5) and 32.3%, 29.8, and 25.2% of the study participants visited outpatient clinics for foot, knee, and hip problems respectively. The Cronbach’s alpha coefficients of 7 sub-domains in K-PROMIS-29 V2.1 ranged from 0.80 to 0.95, indicating satisfactory internal consistency. In CFA, the goodness-of-fit indices were high (CFI = 0.937 and SRMR = 0.061). High to moderate correlations were found between comparable subscales of the K-PROMIS-29 V2.1 and subscales of the SF-36v2 (r = 0.55–0.70). Conclusions The K-PROMIS-29 V2.1 is a reliable and valid measure for assessing a broad range of health-related quality-of-life domains in patients with LEP. It would reflect the real-life symptoms experienced by patients with LEP.
Article
Objectives To identify distinct foot pain trajectories over seven years and examine their associations with potential prognostic factors. Methods Adults aged ≥50 years registered with four general practices in North Staffordshire, UK were mailed a baseline health survey. Those reporting current or recent foot pain were invited to attend a research assessment clinic. Follow-up was by repeated postal surveys at 18, 36, 54, and 84 months. Distinct trajectories of foot pain were explored using Latent Class Growth Analysis (LCGA). Subsequently, identified trajectories were combined into most and least progressive groups and covariate-adjusted associations with a range of prognostic factors examined. Results Of 560 adults with foot pain attending baseline research clinics, 425 (76%) provided data at baseline and ≥2 follow-up time-points. LCGA for foot pain severity (0-10 Numerical Rating Scale) identified a four-trajectory model: ‘mild, improving’ (37%); ‘moderate, improving’ (33%); ‘moderate-severe, persistent; (24%); ‘severe, persistent’ (6%). Compared with individuals in more favourable (‘improving’) pain trajectories, those in less favourable (‘persistent’) pain trajectories were more likely to be obese, have routine/manual and intermediate occupations, poorer physical and mental health, catastrophising beliefs, greater foot-specific functional limitation, and self-assessed hallux valgus at baseline. Conclusions Four distinct trajectories of foot pain were identified over a seven-year period, with one-third of individuals classified as having pain that is persistently moderate-severe and severe in intensity. The effect of intervening to target modifiable prognostic factors such as obesity and hallux valgus on long-term outcomes in people with foot pain requires investigation.
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This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
Article
The objective is to determine the prevalence of self-reported physician-diagnosed osteoarthritis (OA) and musculoskeletal symptoms (pain, stiffness or discomfort) in specific joints among adults in British Columbia (BC), Canada. We carried out a cross-sectional mixed-mode survey in a random population sample of persons 18 years of age and older. Estimates were weighted to reflect the age and sex distribution of the population of BC. We obtained responses from 2,233 individuals. Overall, 18.4% (95% CI 16.8–20.1) of the adult population reported OA. Of those, more than 40% had OA in multiple sites. Prevalence ranged from 8.8% (95% CI 7.6–10.1) in the knee to 2.7% (2.1–3.5) in the foot. One-year prevalence of symptoms ranged from 49.1% (47.0–51.2) in the lower back to 23.3% (21.5–25.1) in the hip. Females reported more symptoms and OA than males in all joints. The most common site of self-reported physician-diagnosed OA in BC is the knee, but OA in the hands, hips, and feet is also common. Having OA in one joint is a strong predictor of OA in other joints.
Article
Ultrasonography (US) is a useful diagnostic method that can be easily applied to identify the cause of metatarsalgia. The superficial location of structures in the foot, dynamic capability of US, and the ability to perform direct real-time evaluations of the pain site are also strong advantages of US as a modality for examining the foot. Moreover, knowing the possible pain sources to investigate when a patient has a specific site of pain will enhance the diagnostic quality of US, and will help radiologists to perform US efficiently and effectively. The purpose of this article is to review the common etiologies of metatarsalgia including Morton's neuroma, plantar plate injury, synovitis, tenosynovitis, bursitis, and metatarsal fractures, and to discuss their US features.
Article
The European Foot and Ankle Society (EFAS) score is a recently developed foot and ankle patient reported outcome measure. It has been developed and partly validated in seven languages. This study's aim was to investigate the measurement properties of the Dutch version of the EFAS score. Subscales of the Dutch EFAS score were evaluated in 547 patients with a variety of foot and ankle diagnoses. Floor and ceiling effect, reliability and construct validity were assessed. The internal consistency of the EFAS score was acceptable (Cronbach's alpha 0.79-0.94). Repeatability was considered poor, with intraclass correlation coefficients between 0.32 and 0.39. Construct validity was inadequate with confirmation of 67% of the hypothesized correlations. In conclusion, the Dutch version of the EFAS score does not have adequate measurement properties for use in patient with patients with varying foot and ankle problems.
Article
Objectives Foot and ankle dysfunction in barefoot/minimally shod populations remains understudied. Although factors affecting musculoskeletal pain in Western populations are well-studied, little is known about how types of work, gender, and body shape influence bone and joint health in non-Western and minimally shod communities. This study examines the effect of human variation on locomotor disability in an agrarian community in Madagascar. Materials and methods Foot measurements were collected along with height, weight, age, and self-report data on daily activity and foot and ankle pain from 41 male and 48 female adults. A short form revised foot function index (FFI-R), that measures functional disability related to foot pain, was calculated. Raw and normalized foot measurements were compared by gender and used in a multiple linear regression model to determine predictors of FFI-R. Results Compared to men, women reported higher FFI-R scores (p = 0.014), spent more time on their feet (p = 0.019), and had higher BMIs (p = 0.0001). For their weight, women had significantly smaller and narrower feet than men. Bimalleolar breadth (p = 0.0005) and foot length (p = 0.0223) standardized by height, time spent on feet (p = 0.0102), ankle circumference standardized by weight (p = 0.0316), and age (p = 0.0090) were significant predictors of FFI-R score. Discussion Our findings suggest that human variation in anatomical and behavioral patterns serve as significant explanations for increased foot and ankle pain in women in this non-Western rural population. Foot and ankle pain were prevalent at similar levels to those in industrialized populations, indicating that research should continue to examine its effect on similar barefoot/minimally shod communities.
Article
Background Valgus hindfoot is a very common postural deviation, and the associated foot pronation can be a triggering factor for diseases such as tarsal tunnel syndrome. Research question This work compares two techniques for hindfoot valgus correction: GPR (Global Postural Reeducation) and PIMT (Postural Integration by Manual Therapy). Methods Sixty young adult subjects from the Brazilian Army with unilateral hindfoot valgus were selected and divided into two groups of 30 subjects, one treated with GPR and the other treated with PIMT. Differences between normal and valgus hindfeet (plantar surface and body weight load) for each subject were measured and analysed, using a baropodometer with subjects in static standing position for 5 seconds. Measurements were performed before and after each treatment session (4 weeks, once a week), and 4 weeks after the end of treatment. Results These data showed that both treatments were equally effective for improving symmetry in body weight load between feet and plantar surface. After 4 weeks from the end of treatment, both treatments were equally effective for body weight load symmetry, but plantar surface symmetry was better in PIMT treated subjects. Significance This study shows that PIMT technique can be validated as a physical therapy procedure, at least for valgus hindfoot.
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Osseous or soft tissue impingement of the anterior ankle can result in reduced dorsiflexion, pain and difficulty in walking that can significantly reduce the quality of life. Sometimes, conservative treatments fail and surgical intervention may be indicated. A 34-year-old male, who sustained a severe ankle injury five years earlier whilst waterskiing, complained of ongoing pain and disability. His initial injury had resulted in multiple fracture fragments within the anterior and posterior aspects of his right ankle. Upon performing clinical examination, reduced dorsiflexion with crepitus was noted and plain film radiographs exhibited multiple fragments within the anterior and posterior aspects of his ankle joint. Pain and limitation to motion were primarily affecting the anterior joint. The posterior aspect was only mildly symptomatic and not considered a primary consideration. Treatment involved a mini-open arthroplasty with removal of the osteophytes and margination of the chondral defects. Adequate dorsiflexion without crepitus was noted on the operating table and postoperative radiographs showed adequate removal of the osteophytes. He was kept non-weight bearing in a fibreglass back slab for 10 days before resuming partial weight bearing in a postoperative shoe and crutches. Mini-open arthroplasty may offer a viable alternative to large incision joint procedures or arthroscopy and may be a procrastinatory procedure for patients wishing to delay ankle joint arthrodesis or replacement.
Article
Objective The aim of the study was to describe patterns of referral to podiatrists by general practitioners (GPs) in Australia. Study design This is a continuous cross-sectional study of Australian general practice activity. Methods We analysed data from the Bettering the Evaluation and Care of Health program, collected from April 2000 to March 2016 inclusive. Data were summarised using descriptive statistics with 95% confidence intervals around point estimates. Multivariate logistic regression was used to identify GP and patient characteristics independently associated with referral. Results The data set included 1,568,100 encounters, including 5,912 podiatry referrals. Referrals increased from 7.0 to 39.5 per 1000 population over the evaluation period. In multivariate analyses, female GPs were more likely than male GPs to refer, and GPs aged ≥55 years were less likely to refer. Patients referred to podiatrists were more likely to be aged ≥85 years, be Indigenous, be from an English-speaking background and have previously been seen at the practice. The problem generating the highest number of referrals was diabetes. After the introduction of Medicare funding, referred patients were more likely to be women, be aged >45 years, have a healthcare card, be socio-economically disadvantaged and have previously been seen at the practice. Conclusions GP referral to podiatrists in Australia increased markedly after the introduction of Medicare funding and appears to be targeted to those with the greatest need. Further research is required to determine whether this policy has improved outcomes and is cost-effective.
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Chronic heel pain is a challenging diagnosis and although it is a common and disabling condition frequently mistreated. Baxter Nerve (BN) entrapment is responsible for 20% of heel pain and can be managed by an ultrasound guide nerve block, a simple, safe, and durable technique. A 67-year-old woman complained of paraesthesia on the left heel and a “stepping on glass” feeling. Various techniques were performed to manage her symptoms without any results. An ultrasound BN block was finally performed with an instant relief and satisfactory pain control for the follow-up period of 6 months. This clinical report highlights the success of the ultrasound BN block as an effective and lasting solution for chronic heel pain.
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BACKGROUND: This is an update of the original Cochrane review first published in Issue 1, 2003, and previously updated in 2009 and 2012. Chronic pain affects many children, who report severe pain, disability, and distressed mood. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This update focuses specifically on psychological therapies delivered face-to-face, adds new randomised controlled trials (RCTs), and additional data from previously included trials. OBJECTIVES: There were three objectives to this review. First, to determine the effectiveness on clinical outcomes of pain severity, disability, depression, and anxiety of psychological therapy delivered face-to-face for chronic and recurrent pain in children and adolescents compared with active treatment, waiting-list, or standard medical care. Second, to evaluate the impact of psychological therapies on depression and anxiety, which were previously combined as 'mood'. Third, we assessed the risk of bias of the included studies and the quality of outcomes using the GRADE criteria. SEARCH METHODS: Searches were undertaken of CENTRAL, MEDLINE, EMBASE, and PsycINFO. We searched for further RCTs in the references of all identified studies, meta-analyses, and reviews. Trial registry databases were also searched. The date of most recent search was January 2014. SELECTION CRITERIA: RCTs with at least 10 participants in each arm post-treatment comparing psychological therapies with active treatment, standard medical care, or waiting-list control for children or adolescents with episodic, recurrent or persistent pain were eligible for inclusion. Only trials conducted in person (face-to-face) were considered. Studies that delivered treatment remotely were excluded from this update. DATA COLLECTION AND ANALYSIS: All included studies were analysed and the quality of outcomes were assessed. All treatments were combined into one class, psychological treatments. Pain conditions were split into headache and non-headache. Both conditions were assessed on four outcomes: pain, disability, depression, and anxiety. Data were extracted at two time points; post-treatment (immediately or the earliest data available following end of treatment) and at follow-up (between three and 12 months post-treatment). MAIN RESULTS: Seven papers were identified in the updated search. Of these papers, five presented new trials and two presented follow-up data for previously included trials. Five studies that were previously included in this review were excluded as therapy was delivered remotely. The review thus included a total of 37 studies. The total number of participants completing treatments was 2111. Twenty studies addressed treatments for headache (including migraine); nine for abdominal pain; two for mixed pain conditions including headache pain, two for fibromyalgia, two for recurrent abdominal pain or irritable bowel syndrome, and two for pain associated with sickle cell disease.Analyses revealed psychological therapies to be beneficial for children with chronic pain on seven outcomes. For headache pain, psychological therapies reduced pain post-treatment and at follow-up respectively (risk ratio (RR) 2.47, 95% confidence interval (CI) 1.97 to 3.09, z = 7.87, p < 0.01, number needed to treat to benefit (NNTB) = 2.94; RR 2.89, 95% CI 1.03 to 8.07, z = 2.02, p < 0.05, NNTB = 3.67). Psychological therapies also had a small beneficial effect at reducing disability in headache conditions post-treatment and at follow-up respectively (standardised mean difference (SMD) -0.49, 95% CI -0.74 to -0.24, z = 3.90, p < 0.01; SMD -0.46, 95% CI -0.78 to -0.13, z = 2.72, p < 0.01). No beneficial effect was found on depression post-treatment (SMD -0.18, 95% CI -0.49 to 0.14, z = 1.11, p > 0.05). At follow-up, only one study was eligible, therefore no analysis was possible and no conclusions can be drawn. Analyses revealed a small beneficial effect for anxiety post-treatment (SMD -0.33, 95% CI -0.61 to -0.04, z = 2.25, p < 0.05). However, this was not maintained at follow-up (SMD -0.28, 95% CI -1.00 to 0.45; z = 0.75, p > 0.05).Analyses revealed two beneficial effects of psychological treatment for children with non-headache pain. Pain was found to improve post-treatment (SMD -0.57, 95% CI -0.86 to -0.27, z = 3.74, p < 0.01), but not at follow-up (SMD -0.11, 95% CI -0.41 to 0.19, z = 0.73, p > 0.05). Psychological therapies also had a beneficial effect for disability post-treatment (SMD -0.45, 95% CI -0.71 to -0.19, z = 3.40, p < 0.01), but this was not maintained at follow-up (SMD -0.35, 95% CI -0.71 to 0.02, z = 1.87, p > 0.05). No effect was found for depression or anxiety post-treatment (SMD -0.07, 95% CI -0.30 to 0.17, z = 0.54, p > 0.05; SMD -0.15, 95% CI -0.36 to 0.07, z = 1.33, p > 0.05) or at follow-up (SMD 0.06, 95% CI -0.16 to 0.28, z = 0.53, p > 0.05; SMD 0.05, 95% CI -0.24 to 0.33, z = 0.32, p > 0.05). AUTHORS' CONCLUSIONS: Psychological treatments delivered face-to-face are effective in reducing pain intensity and disability for children and adolescents (<18 years) with headache, and therapeutic gains appear to be maintained, although this should be treated with caution for the disability outcome as only two studies could be included in the follow-up analysis. Psychological therapies are also beneficial at reducing anxiety post-treatment for headache. For non-headache conditions, psychological treatments were found to be beneficial for pain and disability post-treatment but these effects were not maintained at follow-up. There is limited evidence available to estimate the effects of psychological therapies on depression and anxiety for children and adolescents with headache and non-headache pain. The conclusions of this update replicate and add to those of the previous review which found that psychological therapies were effective in reducing pain intensity for children with headache and non-headache pain conditions, and these effects were maintained at follow-up for children with headache conditions.
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Background: Subjectively reported health complaints account for approximately 50% of all long-term sickness compensation and permanent disability in Northern European countries. The prevalence of these complaints in the population at large was examined. Methods: Data from national surveys conducted in 1993 of 2,030 men and 2,016 women above 15 years of age in Denmark, Finland, Norway, and Sweden were analysed. Results: As many as 75% of our sample had at least some subjective health complaints for the previous 30 days. More than 50% had experienced tiredness, 42% headache, 37% worry, 35% low back pain and 33% pain in their arms or shoulders. The prevalence was higher in women than in men. In general, substantial muscle pain was more common in older subjects, but tiredness, headache, worry and depressive mood were more common in young subjects. Conclusion: The very high prevalence of these complaints in the general population should be taken into account whenever these complaints are reported to be due to any new environmental factor or disease.
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Falls are the sixth leading cause of death in elderly people in the U.S. Despite progress in understanding risk factors for falls, many suspected risk factors have not been adequately studied. Putative risk factors for falls such as pain, reductions in cerebral blood flow, somatosensory deficits, and foot disorders are poorly understood, in part because they pose measurement challenges, particularly for large observational studies. The MOBILIZE Boston Study (MBS), an NIA-funded Program Project, is a prospective cohort study of a unique set of risk factors for falls in seniors in the Boston area. Using a door-to-door population-based recruitment, we have enrolled 765 persons aged 70 and older. The baseline assessment was conducted in 2 segments: a 3-hour home interview followed within 4 weeks by a 3-hour clinic examination. Measures included pain, cerebral hemodynamics, and foot disorders as well as established fall risk factors. For the falls follow-up, participants return fall calendar postcards to the research center at the end of each month. Reports of falls are followed-up with a telephone interview to assess circumstances and consequences of each fall. A second assessment is performed 18 months following baseline. Of the 2382 who met all eligibility criteria at the door, 1616 (67.8%) agreed to participate and were referred to the research center for further screening. The primary reason for ineligibility was inability to communicate in English. Results from the first 600 participants showed that participants are largely representative of seniors in the Boston area in terms of age, sex, race and Hispanic ethnicity. The average age of study participants was 77.9 years (s.d. 5.5) and nearly two-thirds were women. The study cohort was 78% white and 17% black. Many participants (39%) reported having fallen at least once in the year before baseline. Our results demonstrate the feasibility of conducting comprehensive assessments, including rigorous physiologic measurements, in a diverse population of older adults to study non-traditional risk factors for falls and disability. The MBS will provide an important new data resource for examining novel risk factors for falls and mobility problems in the older population.
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Abstract Background Falls are the sixth leading cause of death in elderly people in the U.S. Despite progress in understanding risk factors for falls, many suspected risk factors have not been adequately studied. Putative risk factors for falls such as pain, reductions in cerebral blood flow, somatosensory deficits, and foot disorders are poorly understood, in part because they pose measurement challenges, particularly for large observational studies. Methods The MOBILIZE Boston Study (MBS), an NIA-funded Program Project, is a prospective cohort study of a unique set of risk factors for falls in seniors in the Boston area. Using a door-to-door population-based recruitment, we have enrolled 765 persons aged 70 and older. The baseline assessment was conducted in 2 segments: a 3-hour home interview followed within 4 weeks by a 3-hour clinic examination. Measures included pain, cerebral hemodynamics, and foot disorders as well as established fall risk factors. For the falls follow-up, participants return fall calendar postcards to the research center at the end of each month. Reports of falls are followed-up with a telephone interview to assess circumstances and consequences of each fall. A second assessment is performed 18 months following baseline. Results Of the 2382 who met all eligibility criteria at the door, 1616 (67.8%) agreed to participate and were referred to the research center for further screening. The primary reason for ineligibility was inability to communicate in English. Results from the first 600 participants showed that participants are largely representative of seniors in the Boston area in terms of age, sex, race and Hispanic ethnicity. The average age of study participants was 77.9 years (s.d. 5.5) and nearly two-thirds were women. The study cohort was 78% white and 17% black. Many participants (39%) reported having fallen at least once in the year before baseline. Conclusion Our results demonstrate the feasibility of conducting comprehensive assessments, including rigorous physiologic measurements, in a diverse population of older adults to study non-traditional risk factors for falls and disability. The MBS will provide an important new data resource for examining novel risk factors for falls and mobility problems in the older population.
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Unlabelled: Sex-related influences on pain and analgesia have become a topic of tremendous scientific and clinical interest, especially in the last 10 to 15 years. Members of our research group published reviews of this literature more than a decade ago, and the intervening time period has witnessed robust growth in research regarding sex, gender, and pain. Therefore, it seems timely to revisit this literature. Abundant evidence from recent epidemiologic studies clearly demonstrates that women are at substantially greater risk for many clinical pain conditions, and there is some suggestion that postoperative and procedural pain may be more severe among women than men. Consistent with our previous reviews, current human findings regarding sex differences in experimental pain indicate greater pain sensitivity among females compared with males for most pain modalities, including more recently implemented clinically relevant pain models such as temporal summation of pain and intramuscular injection of algesic substances. The evidence regarding sex differences in laboratory measures of endogenous pain modulation is mixed, as are findings from studies using functional brain imaging to ascertain sex differences in pain-related cerebral activation. Also inconsistent are findings regarding sex differences in responses to pharmacologic and non-pharmacologic pain treatments. The article concludes with a discussion of potential biopsychosocial mechanisms that may underlie sex differences in pain, and considerations for future research are discussed. Perspective: This article reviews the recent literature regarding sex, gender, and pain. The growing body of evidence that has accumulated in the past 10 to 15 years continues to indicate substantial sex differences in clinical and experimental pain responses, and some evidence suggests that pain treatment responses may differ for women versus men.
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Few population-based studies have examined the prevalence of foot pain in the general community. The aims of this study were therefore to determine the prevalence, correlates and impact of foot pain in a population-based sample of people aged 18 years and over living in the northwest region of Adelaide, South Australia. The North West Adelaide Health Study is a representative longitudinal cohort study of n = 4,060 people randomly selected and recruited by telephone interview. The second stage of data collection on this cohort was undertaken between mid 2004 and early 2006. In this phase, information regarding the prevalence of musculoskeletal conditions was included. Overall, n = 3,206 participants returned to the clinic during the second visit, and as part of the assessment were asked to report whether they had pain, aching or stiffness on most days in either of their feet. Data were also collected on body mass index (BMI); major medical conditions; other joint symptoms and health-related quality of life (the Medical Outcomes Study Short Form 36 [SF-36]). Overall, 17.4% (95% confidence interval 16.2 - 18.8) of participants indicated that they had foot pain, aching or stiffness in either of their feet. Females, those aged 50 years and over, classified as obese and who reported knee, hip and back pain were all significantly more likely to report foot pain. Respondents with foot pain scored lower on all domains of the SF-36 after adjustment for age, sex and BMI. Foot pain affects nearly one in five of people in the community, is associated with increased age, female sex, obesity and pain in other body regions, and has a significant detrimental impact on health-related quality of life.
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To determine the prevalence and sites of musculoskeletal complaints and some associated health consequences among elderly Chinese. A random sample of all subjects aged 70 years and over stratified by age and sex. Information collected by questionnaire at an interview. Nineteen to 41% of subjects complained of pain at various sites restricting activities, with a higher prevalence for women. The most common 4 sites involved in order of frequency were knee, upper back, ankle/foot, and shoulder. Back pain increased with age in men to reach the same frequency as women in the 90+ age group. Between 6 to 10% of men and 9 to 14% of women used nonsteroidal antiinflammatory drugs. Pain limiting activities were associated with a lower Barthel index, use of walking aids, increased frequency of doctor consultations, sleep disturbance, and higher depressive symptom scores. Prevention of conditions resulting in musculoskeletal complaints would be important in the promotion of healthy active life expectancy in the elderly.
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to investigate changes in functional ability and physical health, psychiatric morbidity, life satisfaction, service use and social support. a structured interview survey of three samples of elderly people living at home at two points in time. The three samples comprised one census of people aged 85 and over [City (of London) and Hackney], and two random samples of people aged 65-84 (City and Hackney and Braintree). The follow-up interviews took place 2.5-3 years after the baseline interviews. City and Hackney (East London) and Braintree (Essex). Respondents were interviewed at home by one of 12 trained interviewers. 630 people aged 85+ at baseline (70% response rate) and 78% of survivors re-interviewed at follow-up; 464 people aged 65-84 in Hackney at baseline (67% response rate), and 83% of survivors re-interviewed; 276 people aged 65-84 in Braintree at baseline (82% response rate), and 78% of survivors re-interviewed. scores on scales of functional ability, psychiatric morbidity, life satisfaction and social support, and items measuring number and type of health symptoms and services used. decreasing levels of physical functioning were associated with poor mental health, trouble with feet and problems with muscles and joints. There were no associations with level of physical functioning and use of rehabilitative or general medical services, use of social worker or carer relief. Few respondents used preventive or rehabilitation services.
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Epidemiologically-based rheumatology healthcare needs assessment requires an understanding of the incidence and prevalence of musculoskeletal disorders in the community, of the reasons why people consult in primary care, and of the proportion of people who would benefit from referral to secondary care and paramedical services. This paper reports the first phase of such a needs assessment exercise. To estimate the relative frequency of musculoskeletal pain in different, and multiple, anatomical sites in the adult population. Three general practices in the former Tameside and Glossop Health Authority, Greater Manchester, UK, a predominantly urban area. Population survey. An age and sex stratified sample of 6000 adults from the three practices was mailed a questionnaire that sought data on demographic factors, musculoskeletal symptoms (pain in the past month lasting for more than a week), and physical disability (using the modified Health Assessment Questionnaire--mHAQ). The areas of pain covered were neck, back, shoulder, elbow, hand, hip, knee, and multiple joints. The Carstairs index was used as a measure of social deprivation of the postcode sector in which the person lived. The response rate after two reminders was 78.5%. Non-responders were more likely to live in areas of high social deprivation. People who lived in more deprived areas were also more likely to report musculoskeletal pain, especially backpain. After adjusting for social deprivation the rates of musculoskeletal pain did not differ between the practices and so their results were combined. After adjustment for social deprivation, the most common site of pain was back (23%; 95% CI 21, 25) followed by knee (19%; 95% CI 18, 21), and shoulder (16%; 95% CI 14, 17). The majority of subjects who reported pain had pain in more than one site. The prevalence of physical disability in the community rose with age. It was highest in those with multiple joint problems but was also high in those with isolated back or knee pain. Musculoskeletal pain is common in the community. People who live in socially deprived areas have more musculoskeletal symptoms. Estimates of the overall burden of musculoskeletal pain that combine the results of site specific surveys will be too high, those that do not adjust for socioeconomic factors will be too low.
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Environmental factors such as farming contribute to the frequency of joint symptoms. The purpose of this study is to explore the possible role of environment (lifestyle), by comparing the prevalence of joint pain between Japanese in a rural farming district in Japan and in urban Hawaii. Current or previous pain at specific joints was surveyed among 222 women in rural Japan and 638 Japanese women in urban Hawaii aged 60-79. The age adjusted prevalence was compared using logistic regression. The prevalence of pain at one or more joints was approximately 70% in Japan and 50% in Hawaii. The prevalence of knee pain in Japan ranged from 36% at ages 60-69 years to 53% at 70-79 years (mean 41%), whereas knee pain affected only 20% of women in Hawaii in both age groups. The odds ratio (and 95% CI) was 3.2 (2.1, 4.8) for knee pain, and 4.0 (2.2, 7.4) for mid-back pain in Japan, compared with Hawaii. Pain was also significantly more common in Japan at the shoulder, elbow, and ankle, but not at other joints. Women in Japan were shorter and weighed less than in Hawaii. Adjustment for body mass index increased the odds ratios to 4.4 (2.9, 6.8) for knee, and 4.5 (2.4, 8.5) for mid-back pain. Although the potential influence of cultural factors or other sources of bias cannot be ruled out, the large differences in the prevalence of pain at specific joints suggest that environmental factors are probably responsible, because both populations are of similar genetic stock.
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The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.
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To investigate the incidence and prevalence of shoulder complaints in the general population. A systematic review of the literature was conducted. Medline, Embase, and Cinahl were searched for relevant studies. Eighteen studies on prevalence and one study on incidence met the inclusion criteria. Incidence figures of 0.9-2.5% were found for different age groups. Prevalence figures differed from 6.9 to 26% for point prevalence, 18.6-31%, for 1-month prevalence, 4.7-46.7% for 1-year prevalence and 6.7-66.7% for lifetime prevalence. Prevalence rates decreased when the case definition was restricted, in terms of duration of pain or the presence of limited movements, and increased when the location for pain was enlarged. The reported prevalence figures on shoulder complaints diverged strongly. Health professionals and policymakers who estimate the amount of medical care needed and related costs should be aware of the variations in prevalence rate and the underlying reasons for these differences.
Article
One thousand and thirty-seven households, distributed throughout Great Britain in accordance with national socio-economic groupings, were surveyed by telephone with respect to the prevalence of chronic pain. One hundred and ninety-two households contained one or more persons in chronic pain; out of a total household population of 2942, 208 adults (7 per cent) were in pain. Although the mean age of chronic pain sufferers was 44, 51 per cent of them were over the age of 54; however, 56 per cent were between 25 and 65. There were important geographical variations, with the proportion of pain sufferers in southern England being only a little over half of that pertaining in other regions. 'Arthritis/rheumatism' was by far the commonest cause cited for chronic pain; and the back, followed by the lower limb, the commonest locations. Seventy per cent of subjects stated that they were taking 'painkillers'; yet they were still in pain. Sixty-three per cent of subjects experienced pain on each of the 7 days preceding the survey. Fifty-five per cent stated that they were unable to lead a normal life because of pain; the majority of these were over 45 years of age. The health, social and economic consequences of these findings are briefly discussed.
Article
The authors conducted a mail survey that examined foot problems, rates of utilization of foot-health services, and the perception of foot problems as medical conditions in a sample of people aged 65 years and older who lived independently. Although 71% of the 128 respondents reported suffering from foot problems, only 39% had consulted medical personnel about their feet, and only 26% identified their foot pathologies as medical conditions. More female than male respondents experienced foot problems and had visited medical personnel about their feet. Increased education of older individuals about their foot-care requirements, as well as increased access to pediatric medical services, is recommended.
Article
Information on the prevalence of pain in the general population has relevance for the allocation of health services and for understanding of chronic pain.In 1986 a sample of 1498 adults were interviewed using the Diagnostic Interview Schedule. Questions on pain were taken from the somatisation section of the interview schedule. These responses were used to determine the lifetime prevalence of pain in the urban population of New Zealand.The majority of subjects reported more than one life disrupting experience of pain. Pain was most common in the joints, back, head and abdomen. Women reported more pain than men. In general the prevalence of pain increased with age, however this was not true for headaches and abdominal pain. Most subjects related their pain symptoms to a physical cause.
Article
In a postal survey, we asked 1009 randomly chosen individuals, age 18–84, about their pain problems. The pain prevalence depended on what types of questions were asked. Any pain or discomfort, including even a problem of short duration, was reported by 66% of those questioned. Forty percent reported ‘obvious pain’ (pain which affected them ‘to quite a high degree’ or more and was ‘like being stiff after exercise’ or worse) lasting more than 6 months. Pain problems of more than 6 months duration were reported far more often than short-lasting problems. Continuous or nearly continuous pain problems were reported as frequently as problems recurring regularly or irregularly. Pains in the neck, shoulders, arms, lower back and legs were most frequent. The prevalence of ‘obvious pain’ in these localizations was 15–20%. Pain was reported most frequently in the age group 45–64, where the prevalence of ‘obvious pain’ was 50% among males as well as females. Over 65 years of age the prevalence was less.
Article
Background: Subjectively reported health complaints account for approximately 50% of all long-term sickness compensation and permanent disability in Northern European countries. The prevalence of these complaints in the population at large was examined. Methods: Data from national surveys conducted in 1993 of 2,030 men and 2,016 women above 15 years of age in Denmark, Finland, Norway, and Sweden were analysed. Results: As many as 75% of our sample had at least some subjective health complaints for the previous 30 days. More than 50% had experienced tiredness, 42% headache, 37% worry, 35% low back pain and 33% pain in their arms or shoulders. The prevalence was higher in women than in men. In general, substantial muscle pain was more common in older subjects, but tiredness, headache, worry and depressive mood were more common in young subjects. Conclusion: The very high prevalence of these complaints in the general population should be taken into account whenever these complaints are reported to be due to any new environmental factor or disease.
Article
Musculoskeletal complaints are common. In a population survey in a local community 40 kilometres northeast of Oslo, only 15% did not report musculoskeletal symptoms during the last year. Just as many, 15% reported musculoskeletal symptoms every day. 53% reported that they had experienced low back pain during the last year. Corresponding figures for headache were 49% neck symptoms 48% and shoulder symptoms 46% Headaches were most common among younger women, neck and shoulder symptoms among middle-aged women, while hip and knee symptoms were more frequent in elderly women. Women in all age groups reported symptoms from more parts of the body than men. © 1995 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
Book
The Cochrane Handbook for Systematic Reviews of Interventions (the Handbook) has undergone a substantial update, and Version 5 of the Handbook is now available online at www.cochrane-handbook.org and in RevMan 5. In addition, for the first time, the Handbook will soon be available as a printed volume, published by Wiley-Blackwell. We are anticipating release of this at the Colloquium in Freiburg. Version 5 of the Handbook describes the new methods available in RevMan 5, as well as containing extensive guidance on all aspects of Cochrane review methodology. It has a new structure, with 22 chapters divided into three parts. Part 1, relevant to all reviews, introduces Cochrane reviews, covering their planning and preparation, and their maintenance and updating, and ends with a guide to the contents of a Cochrane protocol and review. Part 2, relevant to all reviews, provides general methodological guidance on preparing reviews, covering question development, eligibility criteria, searching, collecting data, within-study bias (including completion of the Risk of Bias table), analysing data, reporting bias, presenting and interpreting results (including Summary of Findings tables). Part 3 addresses special topics that will be relevant to some, but not all, reviews, including particular considerations in addressing adverse effects, meta-analysis with non-standard study designs and using individual participant data. This part has new chapters on incorporating economic evaluations, non-randomized studies, qualitative research, patient-reported outcomes in reviews, prospective meta-analysis, reviews in health promotion and public health, and the new review type of overviews of reviews.
Article
Background: Chronic pain affects many children, who report severe pain, distressed mood, and disability. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This update adds recently published randomised controlled trials (RCTs) to the review published in 2009. Objectives: To assess the effectiveness of psychological therapies, principally cognitive behavioural therapy and behavioural therapy, for reducing pain, disability, and improving mood in children and adolescents with recurrent, episodic, or persistent pain. We also assessed the risk of bias and methodological quality of the included studies. Search methods: Searches were undertaken of MEDLINE, EMBASE, and PsycLIT. We searched for RCTs in references of all identified studies, meta-analyses and reviews. Date of most recent search: March 2012. Selection criteria: RCTs with at least 10 participants in each arm post-treatment comparing psychological therapies with active treatment were eligible for inclusion (waiting list or standard medical care) for children or adolescents with episodic, recurrent or persistent pain. Data collection and analysis: All included studies were analysed and the quality of the studies recorded. All treatments were combined into one class: psychological treatments; headache and non-headache outcomes were separately analysed on three outcomes: pain, disability, and mood. Data were extracted at two time points; post-treatment (immediately or the earliest data available following end of treatment) and at follow-up (at least three months after the post-treatment assessment point, but not more than 12 months). Main results: Eight studies were added in this update of the review, giving a total of 37 studies. The total number of participants completing treatments was 1938. Twenty-one studies addressed treatments for headache (including migraine); seven for abdominal pain; four included mixed pain conditions including headache pain, two for fibromyalgia, two for pain associated with sickle cell disease, and one for juvenile idiopathic arthritis. Analyses revealed five significant effects. Pain was found to improve for headache and non-headache groups at post-treatment, and for the headache group at follow-up. Mood significantly improved for the headache group at follow-up, although, this should be interpreted with caution as there were only two small studies entered into the analysis. Finally, disability significantly improved in the non-headache group at post-treatment. There were no other significant effects. Authors' conclusions: Psychological treatments are effective in reducing pain intensity for children and adolescents (<18 years) with headache and benefits from therapy appear to be maintained. Psychological treatments also improve pain and disability for children with non-headache pain. There is limited evidence available to estimate the effects of psychological therapies on mood for children and adolescents with headache and non-headache pain. There is also limited evidence to estimate the effects on disability in children with headache. These conclusions replicate and add to those of the previous review which found psychological therapies were effective in reducing pain intensity for children with headache and non-headache pain conditions, and these effects were maintained at follow-up.
Article
To identify the methods used in population-based epidemiological studies to diagnose radiographic foot osteoarthritis (OA) and to estimate the population prevalence of radiographic foot OA. Electronic databases searched included Medline, Embase, CINAHL and Ageline (inception to May 2009). The search strategy combined search terms for radiography, OA, foot, and specific foot joints. Predetermined selection criteria were applied. Data extracted from each paper included: sample population, radiographic views taken, foot joints examined, scoring system used, definition of OA applied, reliability of radiographic scoring and prevalence of radiographic OA in the foot. Titles and abstracts of 1035 papers were reviewed and full-texts of 21 papers were obtained. Fifteen papers met inclusion criteria and a further 12 papers were included after screening references. Radiographic views were frequently not specified (NS) but a combination of antero-posterior (AP) and lateral (Lat) views was most commonly reported. The first metatarsophalangeal (MTP) joint was the most commonly examined joint (n=20, 74%). Nineteen studies (70%) used the Kellgren and Lawrence (K&L) grading system, 95% of which defined OA as K&L grade> or =2. Estimates of the prevalence of radiographic first MTP joint OA (defined as K&L> or =2) in middle-aged to older adults ranged from 6.3 to 39%. Significant statistical heterogeneity prevented pooling of prevalence estimates. There are comparatively few studies examining radiographic foot OA. Existing studies mainly focus on the first MTP joint and use the K&L grading system. Future studies are needed to quantify the prevalence of radiographic OA at the different joint complexes within the foot.
Article
Hallux valgus (HV) is common with a standardised prevalence of 28.4% in adults older than 40 years. It has been shown to associate with impaired quality of life (QOL) in small hospital based studies. Previous studies of association between HV, function and disability are based on the presence or absence of regional foot pain which may be due to other foot pathology and is not specific to HV. The objective of this study is to examine the association between self reported HV, big toe pain and impaired QOL in a primary care population. We hypothesise that presence of self-reported HV alone, big toe pain alone and both together will associate with progressively impaired QOL. This hypothesis is based on the known association of concurrent HV and foot pain with impaired physical function and the fact that foot pain and not foot deformity impairs functional status. Our study shows that concurrent HV and big toe pain but not isolated HV associates with impaired overall satisfaction with health and low score on the physical, psychological and social domains of World Health Organization Quality of Life-BREF (WHOQOL-BREF).
Article
To determine the prevalence and severity of foot pain and deformity and the associated risk of leg and low back pain. A cross-sectional postal survey was conducted among a randomly selected sample of 2100 adult Danish inhabitants (18-80 years of age). Participants reported 1-month period prevalences of foot, lower leg, knee, hip and back pain. Responder rate was 79.6%. Prevalence of foot pain was 30.4% with a total of 55.9% reporting pain in the foot, leg or back lasting more than 1 day within the previous month. Foot pain lasting more than 1 month was experienced by 16.2% and 11.9% had pain lasting more than 1 year. The prevalence of self-reported pes planus or pes cavus was 17.9%. There was a significant association between foot pain and pain elsewhere in the leg and low back. Self-reported foot deformity was significantly associated with foot pain. Women had a significantly higher prevalence of foot pain and Body Mass Index was associated with foot pain in women but not in men. Foot pain is highly prevalent and associated with foot deformity and leg and low back pain. More attention should be focused on foot pain and foot deformity. It is suggested that clinical examination of leg and low back pain should include foot examination.
Article
Foot pain is common, yet few studies have examined the condition in relationship to shoewear. In this cross-sectional study of men and women from the population-based Framingham Study, the association between foot pain and type of shoewear was examined. Data were collected on 3,378 members of the Framingham Study who completed the foot examination in 2002-2008. Foot pain (both generalized and at specific locations) was measured by the response to the question "On most days, do you have pain, aching or stiffness in either foot?" Shoewear was recorded for the present time and 5 past age categories, by the subject's choice of the appropriate shoe from a list. The responses were categorized into 3 groups (good, average, or poor shoes). Sex-specific multivariate logistic regression models were used to examine the effect of shoewear (average shoes were the referent group) on generalized and location-specific foot pain, adjusting for age and weight. In women, compared with average shoes, those who wore good shoes in the past were 67% less likely to report hindfoot pain (P = 0.02), after adjusting for age and weight. In men, there was no association between foot pain, at any location, and shoewear, possibly due to the fact that <2% wore bad shoe types, making it difficult to see any relationship. Even after taking age and weight into account, past shoewear use in women remained associated with hindfoot pain. Future studies should address specific support and structural features of shoewear.
Article
To identify a practical definition of disabling foot pain in older adults for clinical and research use, using the Manchester Foot Pain and Disability Index (FPDI). Adults aged > or =50 years registered with three general practices were mailed a two-stage cross-sectional survey. A total of 1342 respondents who reported foot pain in the previous 12 months and completed the FPDI and 58 participants in a test-retest repeatability study were included. Confirmatory factor analysis verified the three-construct FPDI structure (pain intensity, functional limitation and appearance). Internal consistency for the three constructs was good (Cronbach's alpha 0.74, 0.92 and 0.77, respectively). A total of 1320 (98.4%) of those persons with foot pain reported disability (at least one of the 17 FPDI items experienced on at least some days -- Definition A). After restricting this definition to problems experienced on most/every day(s) (Definition B), 996 (74.2%) of those with foot pain reported disability (percentage difference 24.2%; 95% CI 21.9, 26.5%). For each of the three constructs, the prevalence of disability among persons with foot pain was significantly higher under Definition A than under Definition B. Test-retest repeatability for the individual constructs ranged from fair to substantial. Physical function, measured by the SF-36 physical function sub-scale, was poorer in those who reported problems within the function construct compared with those with problems in pain and/or appearance constructs only. A practical definition of disabling foot pain [at least one of the 10 FPDI function items experienced on most/every day(s)] is proposed, which appears valid, repeatable and suitable for use in older adults.
Article
Background: Headache, recurrent abdominal pain, and musculoskeletal pain affect many children, who report severe pain, distressed mood, and disability. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This is a substantially updated and expanded version of the Cochrane review published in 2003. Objectives: To assess the effectiveness of psychological therapies for reducing pain, disability, and improving mood in children and adolescents with recurrent, episodic, or persistent pain. Search strategy: Searches were undertaken of MEDLINE, PsycLIT, EMBASE and CONSORT. RCTs were sought in references of all identified studies, meta-analyses and reviews. Date of most recent search: August 2008. Selection criteria: Randomised Controlled Trials (RCTs) with at least ten participants in each arm post-treatment comparing psychological therapies with placebo, waiting list or standard medical care for children or adolescents with episodic, recurrent or persistent pain, were eligible for inclusion. Data collection and analysis: All included studies were analysed and the quality of the studies recorded. All treatments were combined into one class: psychological treatments; headache and non-headache outcomes were separately analysed on three outcomes: pain, disability, and mood. Main results: Thirty-four RCT studies were recovered; 29 met the inclusion criteria. The total number of participants completing treatments was 1432. Twenty studies addressed treatments for headache (including migraine); six for abdominal pain; one for both headache and abdominal pain, one study was for fibromyalgia, and one was for pain associated with sickle cell disease. The analysis of headache treatment versus control differences immediately post-treatment for pain gave an odds ratio (OR) of 5.51 (95% CI 3.28 to 9.24; z = 6.46, P < 0.05); NNT = 2.57 (CI 2.2 to 3.13). At follow-up, the OR was 9.91 (95% CI 3.73 to 26.33); z = 9.91, P < 0.05); NNT = 1.99 (CI 1.63 to 2.72). Analysis of non-headache treatment versus control differences immediately post-treatment for pain found a large effect size of -0.94 (95% CI -1.43 to -0.44) Z = 3.71, P < 0.05. At follow-up, a large effect size was found of -1.08 (95%CI -1.84 to -0.33); Z = 2.82, P < 0.05). There were no other significant effects. Authors' conclusions: Psychological treatments are effective in pain control for children with headache and benefits appear to be maintained. Psychological treatments may also improve pain control for children with musculoskeletal and recurrent abdominal pain. There is little evidence available to estimate effects on disability or mood.
Article
A survey of the age-sex specific prevalence of joint problems in a population and associated features such as disablement and use of treatment was carried out in 1986 in Calderdale, West Yorkshire, United Kingdom. A postal questionnaire was sent to 25,168 households; 87% were returned, representing households containing 42,826 people aged 16 years and over. Positive answers to a question about pain, swelling, or stiffness in the joints, neck, or back were given by 10,246 subjects, 24% of the population aged 16 years and older, of whom 6181 (60.3%) were women. The rate of reporting of joint problems increased markedly with age, from 5% for subjects aged 16-24 years to 54% for those aged 85 years and older. The joint sites most often reported as affected were the knee and the back, with a frequency in the population of about 10%. The increase in joint problems with age was accompanied by an increase in reported morning stiffness of more than half an hour, taking drugs, and disability, but not in reporting seeing a specialist for these conditions. Of those aged 85 years and older who reported joint problems, most also had difficulty or dependence in activities of daily living. The increasing prevalence of joint problems with age has implications for the provision of care, both in the community and in hospitals, especially in view of the aging of the population as a whole. The planning of health services for those with rheumatic disorders needs to take into account the high incidence of joint problems in the population.
Article
We have assessed foot problems of, and chiropody provision for, 96 people aged 80 years and over who were living at home. Seventy-seven per cent had difficulty cutting their toenails and 30% complained of pain in the feet. The commonest foot problems were corns or callus, abnormal nails, hallux valgus and other toe abnormalities. Only six subjects had normal healthy feet. Of the 47 people receiving chiropody, two-thirds were being seen privately. Private chiropody tended to be performed in the home and was more frequent than National Health Service (NHS) treatment. Fifteen subjects needed but were not having chiropody. Foot problems are common in the very old. We suggest that doctors and nurses should ask old people regularly about problems cutting nails and pain in the feet. At present the provision of chiropody for old people is inadequate and ways of improving foot care must be found.
Article
To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.