Fiona Hawke

Understanding the nature and mechanism of foot pain

Approximately one-quarter of the population are affected by foot pain at any given time. It is often disabling and can impair mood, behaviour, self-care ability and overall quality of life. Currently, the nature and mechanism underlying many types of foot pain is not clearly understood. Here we comprehensively review the literature on foot pain, with specific reference to its definition, prevalence, aetiology and predictors, classification, measurement and impact. We also discuss the complexities of foot pain as a sensory, emotional and psychosocial experience in the context of clinical practice, therapeutic trials and the placebo effect. A deeper understanding of foot pain is needed to identify causal pathways, classify diagnoses, quantify severity, evaluate long term implications and better target clinical intervention.

Custom foot orthoses for the treatment of foot pain: a systematic review

Foot pain affects approximately one quarter of the population at any given time [1,2], is disabling in nearly half of these cases [3] and can impair mood, behaviour, risk of falls, self-care ability and quality of life [4-7]. Custom-made foot orthoses are hypothesised to alleviate foot pain by reducing the biomechanical stress applied to injured tissues [8,9]. We aimed to systematically review the effectiveness of custom-made foot orthoses for the treatment of all types of foot pain.

Toe brachial blood pressure measurement after 5, 10, and 15 minutes of rest

Results TBI inter-rater (ICC 0.71) and test-retest (ICC 0.77) reliability were highest after 15 and 10 minutes of pretest rest respectively. There was a significant increase in TBI between 5 and 10 minutes of pre-test rest (0.032; 95% CI: 0.52 to 0.012; p <0.0001), however the decrease in TBI between 10 and 15 minutes (0.004; 95% CI: -0.023 to 0.015; p = 1.000) was not significant. Conclusion

Factors associated with night‐time calf muscle cramps: A case–control study

Introduction: Although highly prevalent and painful, night‐time calf muscle cramping is poorly understood, and no treatment has shown consistent efficacy or safety. Methods: One hundred sixty adults were recruited from New South Wales, Australia, including 80 who had night‐time calf cramping at least once per week and 80 age‐ and gender‐matched adults who did not. Participants were assessed using reliable tests of lower limb strength, flexibility, morphometrics, circulation, and sensation, and were questioned about health and lifestyle factors, diet, medications, exercise, symptomatology, sleeping habits, and footwear. Results: Conditional logistic regression identified 3 factors independently associated with night‐time calf muscle cramps: muscle twitching (OR 4.6, 95% CI 1.6–15.5, P = 0.01); lower limb tingling (OR 4.1, 95% CI 1.6–10.3, P = 0.003); and foot dorsiflexion weakness (OR 1.02, 95% CI 1.01–1.03, P = 0.002), which represented other measures of lower limb weakness in the model. Conclusions: Night‐time calf muscle cramps were associated with markers of neurological dysfunction and potential musculoskeletal therapeutic targets. Muscle Nerve 47:339‐343, 2013

Evidence-based podiatric medicine importance of systematic reviews in clinical practice

Due to the exponential increase in the quantity and quality of podiatric medicine-related research during the past decade, podiatric physicians are inundated with an insurmountable volume of research relevant to clinical practice. Systematic reviews can refine this literature by using explicit, rigorous, and reproducible methods to identify, critically appraise, and synthesize the best evidence from all clinical trials to answer clearly defined clinical questions. The Cochrane Collaboration is an international not-for-profit organization created to improve the user-friendliness and accessibility of medical literature mainly through preparing and maintaining systematic reviews of health-care interventions. The Cochrane Library currently contains more than 50 podiatric medicine-relevant systematic reviews summarizing and synthesizing evidence from many hundreds of randomized controlled trials evaluating interventions for foot problems. Although more than 60 countries worldwide have open online access to The Cochrane Library, in the United States, only the state of Wyoming has free access to full-text reviews. In an era demanding an evidence-based approach for every clinical intervention, high-quality systematic reviews streamline podiatric medical literature by reducing the time, cost, and training necessary to establish a solid evidence base for practice.

Physical and Mechanical Therapies for Lower-Limb Problems in Juvenile Idiopathic Arthritis

BACKGROUND Juvenile idiopathic arthritis (JIA), a chronic, autoimmune, inflammatory joint disease, is the most common arthritis affecting children younger than 16 years. Children with JIA commonly experience lower-limb dysfunction and disability. We systematically reviewed the effectiveness of physical and mechanical therapies for lower-limb problems in JIA. METHODS Randomized controlled trials of physical and mechanical interventions for lower-limb problems in children with JIA were included. Primary outcome was pain. Secondary outcomes included disability, functional ability, and health-related quality of life. Several databases were searched for eligible studies. Authors of included studies and researchers in the field were contacted to identify additional studies. RESULTS Two studies evaluating the effectiveness of customized/custom foot orthoses in treating foot and ankle pain in children with JIA (N = 100) were included. One study also evaluated simple cushioned inserts. Meta-analyses for comparisons between custom/customized foot orthoses and a control intervention after 3 months were not significant for the outcomes of pain (mean difference, -8.97; 95% confidence interval [CI], -18.01 to 0.07), child-rated health-related quality of life (mean difference, 4.38; 95% CI, -3.68 to 12.44), and parent-rated health-related quality of life (mean difference, 1.77; 95% CI, -6.35 to 9.90). Meta-analyses were supported by sensitivity analyses. CONCLUSIONS There is a paucity of research evaluating physical and mechanical therapies for lower-limb problems in JIA. No physical therapy has been evaluated in randomized controlled trials, and mechanical therapy evaluation is limited to foot orthoses and shoe inserts for foot and ankle pain. The existing research is hampered by small sample sizes. Until further research is conducted, the effectiveness of mechanical and physical therapies for lower-limb problems in JIA remains unclear.

Effect of pre-test rest duration on toe and ankle systolic blood pressure measurements

Background Measurement of toe and ankle blood pressure is used to evaluate the peripheral arterial status of patients, yet the pre-test rest period is inconsistent in published studies and among practitioners, and could affect results. The aim of this systematic review was to evaluate all research that has investigated the effect of different periods of pre-test rest on toe and ankle systolic blood pressure. Methods MEDLINE (from 1946), EMBASE (from 1947), CINAHL (from 1937), and Cochrane Central Register of Controlled Trials (CENTRAL) (from 1800) were searched up to April 2012. No language or publication restrictions were applied. Eighty-eight content experts and researchers in the field were contacted by email to assist in the identification of published, unpublished, and ongoing studies. Studies evaluating the effect of two or more pretest rest durations on toe or ankle systolic blood pressure were eligible for inclusion. No restrictions were placed on participant characteristics or the method of blood pressure measurement. Outcomes included toe or ankle systolic blood pressure and adverse effects. Abstracts were independently assessed by two reviewers for potential inclusion. Results 1658 abstracts were identified by electronic searching. Thirty three of the 88 content experts and researchers in the field replied, identifying five potentially relevant studies. No studies were eligible for inclusion. Conclusion There is no evidence of the effect of different periods of pre-test rest duration on toe and ankle systolic blood pressure measurements. Rigorous trials evaluating the effect of different durations of pre-test rest are required to direct clinical practice and research.

Ganoderma lucidum for the treatment of cardiovascular risk factors

This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this systematic review is to evaluate the effectiveness of Ganoderma lucidum for treatment of pharmacologically modifiable risk factors of cardiovascular disease in adults. This will include determining size, direction, and uncertainty of effect for each risk factor (blood pressure, glucose, cholesterol and triglycerides), and the consistency of effects between studies. The strength and consistency of evidence for adverse events will also be evaluated. 1 Ganoderma lucidum for the treatment of cardiovascular risk factors (Protocol) Copyright

Prevalence, presentation and treatment of lower limb pathologies in juvenile idiopathic arthritis: A narrative review

Juvenile idiopathic arthritis is a chronic, autoimmune, inflammatory joint disease. It is the most common arthritis in children and adolescents. This paper reviews the presentation and treatment of lower limb pathologies in juvenile idiopathic arthritis from an allied health perspective. Common lower limb pathologies include: synovitis causing swelling, tenderness and pain; persistent inflammation leading to flexion contractures; limb length discrepancies; muscle atrophy; enthesopathies such as plantar fasciitis and Achilles tendonitis; and tenosynovitis. Allied health professionals may use a range of non‐invasive therapies, including hydrotherapy, strengthening and stretching exercises, massaging, taping and foot orthoses to manage lower limb pathologies in juvenile idiopathic arthritis. Early detection and treatment of these common and potentially disabling lower limb pathologies are fundamental to achieving gold standard care for children with juvenile idiopathic arthritis.

The effect of pretest rest time on automated measures of toe systolic blood pressure and the toe brachial index.

ObjectivesEvaluation of peripheral blood supply is fundamental to risk categorization and subsequent ongoing monitoring of patients with lower extremity peripheral arterial disease. Toe systolic blood pressure (TSBP) and the toe brachial index (TBI) are both valid and reliable vascular screening techniques that are commonly used in clinical practice. However, the effect of pretest rest duration on the magnitude of these measurements is unclear. MethodsEighty individuals meeting current guidelines for lower extremity peripheral arterial disease screening volunteered to participate. The Systoe and MicroLife automated devices were used to measure toe and brachial systolic blood pressures, respectively, following 5, 10 and 15 min of rest in a horizontal supine position. A ratio of TSBP to brachial pressure was used to calculate the TBI and change in TBI at each time interval was investigated. ResultsA significant increase in TSBP [3.66 mmHg; 95% confidence interval (CI): 1.44–5.89; P⩽0.001] and the TBI (0.03; 95% CI: 0.01–0.05; P⩽0.001) occurred between 5 and 10 min. Between 10 and 15 min, there was a nonsignificant decrease in TSBP (−0.73 mmHg; 95% CI: −1.48 to 2.93; P=1.000) and the TBI (0.00; 95% CI: −0.02 to 0.02; P=1.000). ConclusionTen minutes of pretest rest is recommended for measurement of TSBP and for both pressure measurements used in the calculation of a TBI to ensure that stable pressures are measured.