Jose Antonio Cervera-Marin

Anthropometric Foot Changes During Pregnancy A Pilot Study

BACKGROUND Womens feet change during pregnancy owing to hormonal and anatomical changes, thus having a strong influence on the decrease in their quality of life during pregnancy. This preliminary study aimed to value the anthropometric and positional changes that affect their feet. METHODS Ten pregnant women were measured during their gestational period to analyze the anthropometric changes in their feet from the 12th week of pregnancy. We examined the changes that occured in foot length, forefoot width, arch of the foot height, and the fixed position of the foot by using the Foot Posture Index, and we analyzed three intervals corresponding to pregnancy weeks 12, 24, and 34. RESULTS The most significant finding, with a reliability rate of 95%, is the decrease in internal arch height, which descends 0.65 mm (0.0394 inches) on average at the final stage of the pregnancy period. This change happened in 18 of the feet analyzed, tending toward pronation according to the measure provided by the Foot Posture Index, with a change of 3.78 points on this scale. CONCLUSIONS The foot of the pregnant woman tends to flatten during gestational weeks 12 to 34, taking a more pronated posture, and the anthropometric changes in late pregnancy result in increases in foot length and forefoot width, changes that seem to be moderate.

Development, validation and psychometric analysis of the diabetic foot self-care questionnaire of the University of Malaga, Spain (DFSQ-UMA)

This paper assessed the reliability and construct validity of a tool to evaluate the foot self-care of diabetic patients. The education of diabetic patients about their foot care is a major issue to avoid complications like amputations and ulcers. Specific tools aimed to assess patients knowledge in this area are needed. The study had two phases: in Phase 1, item-generation was carried out through a literature review, expert review by a Delphi technique and cognitive interviews with diabetic patients for testing readability and comprehension. In Phase 2, diabetic patients participated in a cross-sectional study for a psychometric evaluation (reliability and construct validity) was carried out on a sample of type I and II diabetic patients. The study was conducted at the University of Malaga (Spain), podiatric clinics and a Diabetic Foot Unit between October 2012 and March 2013. After psychometric-test analyses on a sample of 209 diabetic patients, the questionnaire resulted in 16 questions. Cronbachs alpha was 0.89 after removing 4 items because of their low reliability. Inter-item correlations gave a mean value of 0.34 (range: 0.06-0.74). The rotated solution showed a 3-factor structure (self-care, foot care, and footwear and socks) that jointly accounted for 60.88% of the variance observed. The correlation between the questionnaire scores and HbA1c was significant and inverse, (r = -0.15; p < 0.01). The findings show that the questionnaire is a valid and reliable tool for evaluating foot self-care behavior in diabetic patients.

Changes in the parameters of gait after a mechanical debridement of a plantar callosities

INTRODUCTION Plantar callosities are a common cause of pain in the forefoot and also a cause of alterations in plantar pressure. Mechanical debridement with a scalpel can relieve pain and increase functional capacity. OBJECTIVE The aim of the study was to analyse if debridement of plantar callosities and corns modify walking. METHODS Thirty four patients with plantar foot pain due to callosities and corns, and up to 5 in the visual analogical scale (VAS) of pain, (20 women, age 29 ± 11.57 years) were analysed by taking into account the changes of their gait. The outcome measurement was the VAS scale and the Win-track system, cycle of the gait(milliseconds), angle(degrees), cadence(number/minutes) and step(centimetres) were measured, 24 h before and after the debridement with a scalpel. RESULTS There were significant differences in foot pain (mean 67.7, p < 0.001) but there were no significant differences in measures of gait variables before the debridement of the callosities, and 24 h after the procedure, being all those above 0.05. CONCLUSIONS Our study shows that the debridement with scalpel does not change the variables of the gait 24 h after the procedure.

Foot orthoses custom-made by vacuum forming on the non-load-bearing foot: Preliminary results in male children with calcaneal apophysitis (Sever's disease)

Background and aim: To our knowledge, the technique of molding orthoses to the non-load-bearing foot is still not widely investigated. The aim of this work is, therefore, first, to describe an off-loading custom-made technique and, second, to explain how it can be specifically adapted to treat Sever’s disease. Techniques: A technique of directly molding orthoses to the non-load-bearing foot by vacuum forming an insole to the foot fabricated with a combination of polyvinyl chloride and polyester resins, 30 Shore A hardness and 148 kg/m3 density polyethylene–ethylene-vinyl-alcohol, and a cushioning heel cup of 22 Shore A polyurethane, using a directly molding orthoses technique to the non-load-bearing foot by vacuum. Discussion: Results show that this new technique could be a good alternative to traditional insoles in the management of Sever’s disease pain. Clinical relevance Manufacturing the insole directly on the patient’s foot could lead to a better individual adaptation in general, and to manage Sever’s pain disease in particular.

Overweight, obesity and foot posture in children: A cross‐sectional study

The aim of this study is to examine the relationship between obesity and foot posture in children.

Normal values of the Foot Posture Index in a young adult Spanish population: a cross-sectional study.

BACKGROUND Although the appearance of foot or lower-limb pathologies is etiologically multifactorial, foot postures in pronation or supination have been related to certain diseases such as patellofemoral syndrome and plantar fasciitis. The objective of the present study was to determine the normal values of foot posture in a healthy young adult Spanish sample, and to identify individuals at risk of developing some foot pathology. METHODS The Foot Posture Index (FPI) was determined in a sample of 635 (304 men, 331 women) healthy young adults (ages 18-30 years). The FPI raw score was transformed into a logit score, and a new classification was obtained with the mean ± 2 SD to identify the 5% of the sample with potentially pathologic feet. RESULTS The normal range of the FPI was -1 to +6, and FPI values from +10 to +12 and -6 to -12 could be classified as indicating potentially pathologic feet. The womens logit FPI (0.50 ± 1.4, raw FPI +3) was higher than the mens (0.25 ± 1.6, raw FPI +2), with the difference being significant (P = 0.038). No statistically significant differences were found between body mass index groups (P = 0.141). CONCLUSIONS The normal FPI range goes from just one point of supination to a certain degree of pronation (+6). The identification of 35 individuals with potentially pathologic feet may help in the implementation of a preventive plan to avoid the appearance of foot disorders.

Assessment of Foot Self-Care in Patients With Diabetes: Retrospective Assessment (2008-2014).

Introduction. The purpose of this article is to assess the current status of the relationship between foot self-care and self-examination and the development of complications of diabetes mellitus. Methodology. A systematic review of articles. We extracted assessments of health habits with regard to educational and training interventions intended for diabetic foot health care. We included clinical trials, meta-analysis, and Cochrane Reviews from 2008 to December 2014. Results. We included 34 articles in this review. The initial number of articles selected was 35, including 12 from PubMed, 12 from Webs of Knowledge, and 4 Cochrane reviews that were considered valid as they complied with the requirements set: they related to interventions reducing foot complications caused by diabetes. Conclusion. Strategies aimed at behavioral changes are effective for the metabolic control of the disease and for the reduction of amputations. However, given the current methodology deficit existing in most studies with regard to sample selection and length of the study, it is necessary to validate a reliable tool or measurement to indicate the status of healthy behavior development and to sustain such measures over time. Levels of Evidence: Therapeutic, Level III: Systematic review of level I-III studies

Structural Changes in the Lower Extremities in Boys Aged 7 to 12 Years Who Engage in Moderate Physical Activity

BACKGROUND Physical activity in children may provide health benefits. We sought to consider the practice of soccer as a possible major factor in the development of the lower limb. The study is based on 3-year data for a group of children who practice this sport. METHODS For 3 years we monitored 53 children who practiced soccer 3 times a week and had engaged in 2 years of continuous sports activity. Their mean ± SD age was 8.49 ± 2.01 years in the first year. Each year, Foot Posture Index, valgus index, subtalar joint axis, and Q angle for the knee were analyzed. RESULTS The mean ± SD Foot Posture Index scores ranged from 5.38 ± 1.79 in the right foot and 4.49 ± 1.67 in the left foot in the first year to 4.64 ± 2.51 and 4.34 ± 2.26, respectively, in the third year. The valgus index for the same period ranged from 14.05° ± 1.51° (right) and 13.88° ± 1.46° (left) to 13.09° ± 1.28° and 13.07° ± 1.07°, respectively. In the knee, the Q angle ranged from 12.83° ± 1.98° (right) and 12.74° ± 1.68° (left) to 13.17° ± 1.45° and 13.26° ± 1.46°, respectively. In the subtalar joint, the changes were 37.73% right and 30.19% left between the first and third years toward a neutral subtalar joint axis. CONCLUSIONS These results show that although playing soccer might cause structural changes in the lower limb, these alterations should not be considered harmful because they may be influenced by age as well.

Cross-cultural adaptation and validation of Spanish version of The Foot and Ankle Ability Measures (FAAM-Sp)

BackgroundThe Foot and Ankle Ability Measure (FAAM) is a Patient Reported Outcome (PRO) commonly used to determine the effectiveness of therapeutic interventions for patients with foot and ankle pathologies and associated impairments of body function and structure, activity limitations, and participation restrictions. The aim of this study was to cross-culturally adapt the FAAM into Spanish.MethodsCross-cultural adaptation was performed according to the international guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Cronbach’s alpha, test re-test reliability, and item-total and inter-item correlations were analyzed. Confirmatory factor analysis (CFA) was carried out to test construct validity. Pearson correlations were calculated to assess the convergent validity between FAAM and EuroQol-5.ResultsSpanish data set comprised 194 patients, with a mean age of 38.45 (16.04) and 130 (67.1%) were female, seeing a podiatrist with a wide variety of foot and ankle related disorders. CFA was carried out to test structure matrix (which has three factors). The test–retest reliability was high with global ICC of 0.95 (95% CI: 0.93 to 0.98). A 15 items version of the FAAM-Sp Activities of Daily Living (ADL) obtained the best fit: relative chi-square (x2/df) of 2.46, GFI 0.90 CFI 0.95, NFI 0.93, and RMSEA 0.08 (90% CI 0.04 to 0.09). For exploratory factor analysis for the FAAM-Sp Sport, a one factor solution was obtained, which explained 76.70% of total variance. CFA corroborated this model with an excellent goodness of fit:: relative chi-square (x2/df) of 0.80, GFI 0.99 CFI 1.00, NFI 0.99, and RMSEA 0.00 (90% CI 0.00 to 0.75).ConclusionsThis study validated a new 15-item FAAM-Sp ADL and FAAM-Sp Sport subscales, which can be used as a self-reported outcome measure in clinical practice and research for patients resident in Spain whose main language is Spanish.

Short-term effect of scalpel debridement of plantar callosities versus treatment with salicylic acid patches: The EMEDESCA randomized controlled trial

This study compares scalpel debridement versus salicylic acid patches in the treatment of plantar callosities. A randomized clinical trial (ACTRN12614000591651) was performed with 62 patients, divided into two intervention groups. Group A received treatment with salicylic acid patches (Callívoro Marthand®) and group B underwent scalpel debridement of plantar callosities. Pain was measured on a visual analog scale, and foot pain and disability were evaluated using the Manchester Foot Pain Disability Index (MFPDI) questionnaire (Spanish version). Significant differences were observed in pain measured immediately after treatment (P < 0.001) and at 15 days and 6 weeks after treatment. For some components, the MFPDI questionnaire revealed significantly better outcomes by scalpel debridement at 15 days after treatment. The scalpel debridement of plantar callosities relieves pain more effectively than salicylic acid patches, and patients achieve greater functionality in the initial weeks after debridement.