The aim of this study was to evaluate the relative contribution of structural foot characteristics and comorbidities to the presence of disabling foot pain in older people. One hundred seventy-two people (55 men and 117 women) aged 62 to 96 years (mean ± SD, 80.1 ± 6.4 years) who lived in a retirement village underwent tests of foot posture, range of motion, and deformity in addition to completing a medical history questionnaire. Disabling foot pain was determined using the Manchester Foot Pain and Disability Index. Thirty-eight subjects (22%) reported disabling foot pain. Subjects with disabling foot pain had a higher body mass index and were more likely to be female; to report osteoarthritis in the spine, hips, hands or wrists, and feet; and to report pain in the back, hips, and hands or wrists. The only significant difference between the groups regarding structural foot characteristics was that those with disabling foot pain exhibited more severe hallux valgus deformity. The strongest determinants of disabling foot pain revealed by a discriminant function analysis were foot osteoarthritis, pain in the hips, and pain in the hands or wrists. These findings indicate that disabling foot pain in older people is more closely related to pain and osteoarthritis in other body regions than to structural characteristics of the foot, and they suggest that more severe forms of foot pain in older people may be a component of a general chronic pain syndrome or a polyarticular form of osteoarthritis. (J Am Podiatr Med Assoc 95(6): 573–579, 2005)
Postural stability is an important component of skilled athletic activity. However, the effects of foot orthoses on stability have not been adequately addressed. This study measured postural sway in 30 asymptomatic professional soccer players in three standing positions and four underfoot conditions. The results revealed that the underfoot condition had no significant effect on sway in the mediolateral or anteroposterior planes; however, there was a trend toward less mediolateral sway when subjects stood in a unipedal position with prefabricated orthoses. These results suggest that insoles and foot orthoses have no significant beneficial or detrimental effects on postural stability in asymptomatic subjects. Clinically, this suggests that no improvements in balance performance could be expected with prophylactic use of insoles or orthoses but that clinicians may prescribe insoles and foot orthoses without fear of impairing postural performance in elite athletes. (J Am Podiatr Med Assoc 91(4): 194-202, 2001)
Podiatric medical students in Australia were surveyed to evaluate their reasons for entering podiatric medicine, knowledge of aging, attitudes toward older people, perceptions of treatment efficacy, and desire to specialize in geriatrics. Few students plan to specialize in geriatrics upon graduation (4%), with most preferring general practice (25%) or sports medicine (21%). However, knowledge of aging was good, and students had favorable attitudes toward older people and considered treatment of older people to be effective. Few age- or gender-related effects were observed. It is concluded that students’ lack of desire to specialize in geriatrics may be due not to unfavorable perceptions of older people but rather to the low profile and limited development of geriatrics as a specialty area within the podiatric medical profession. (J Am Podiatr Med Assoc 93(1): 11-17, 2003)
Osteoarthritis of the knee is a common condition that can cause considerable pain and disability. Various forms of lateral wedging may be effective in the treatment of medial compartment osteoarthritis, but it is not known whether incorporating a lateral wedge into a custom-molded foot orthosis will achieve similar results. Therefore, 30 subjects (21 men and 9 women) aged 29 to 77 years (mean ± SD, 58.1 ± 11.6 years) with radiographically confirmed medial compartment knee osteoarthritis were issued custom-molded foot orthoses with a 5° lateral heel wedge. Pain levels were recorded using a 100-mm visual analog pain scale on the date of issue of the orthoses (baseline) and again 3 and 6 weeks later. Mean ± SD pain levels were significantly reduced at 3 weeks (34 ± 22 mm) and 6 weeks (23 ± 22 mm) versus baseline (69 ± 19 mm) (F2 = 39.57). The degree of pain reduction was greater in patients with less severe osteoarthritis. At 6 weeks, all subjects had achieved at least some reduction in pain, and 28 reported that their orthoses were comfortable. This preliminary study indicates that laterally wedged foot orthoses may be beneficial in the treatment of mild-to-moderate osteoarthritis of the medial compartment of the knee. Further investigations using a larger sample, longer follow-up, and a no-treatment control group seem warranted. (J Am Podiatr Med Assoc 95(4): 347–352, 2005)
This study evaluated two methods for quantifying foot posture: navicular drop and navicular drift. Five clinicians measured 20 nonpathological participants on two occasions. Intraclass correlation coefficients ranged from 0.33 to 0.76 for navicular drop and from 0.31 to 0.62 for navicular drift. The standard error of measurement, as a 95% confidence interval, ranged from ±1.5 mm to ±3.5 mm for navicular drop and ±3 mm to ±5 mm for navicular drift. Intratester reliability was slightly better than intertester reliability for both measurements. These results indicate that both techniques are only moderately reliable, and physicians using these measurements in clinical practice should interpret the values in light of the magnitude of error associated with them. (J Am Podiatr Med Assoc 91(5): 262-268, 2001)
Falls are common in older people and are associated with substantial health-care costs. A recent randomized controlled trial of a multifaceted podiatric medical intervention demonstrated a 36% reduction in the fall rate over 12 months. We evaluated the acceptability of and levels of satisfaction with this intervention in the older people who participated in the trial.
Participants allocated to the intervention group (which included a home-based program of foot and ankle exercises, assistance with the purchase of safe footwear when necessary, and provision of prefabricated foot orthoses) completed a structured questionnaire 6 months after they had received the intervention. The questions addressed participants’ perceptions of their balance and foot and ankle strength, the perceived difficulty of the exercise program, and the degree of satisfaction with the footwear and orthoses provided.
Of 153 participants, 134 (87.6%) attended the 6-month follow-up assessment and completed the questionnaire. Most participants perceived improvements in balance (62.7%) and foot and ankle strength (74.6%) after 6 months of performing the exercises, and 86.6% considered the difficulty level of the exercises to be “about right.” Most participants reported that they were somewhat or very satisfied with the footwear (92.3%) and orthoses (81.6%) provided.
The multifaceted podiatric medical intervention used in this trial was generally perceived to be beneficial and demonstrated high levels of satisfaction among participants. Further research is now required to evaluate the feasibility of implementing the intervention in a range of clinical practice settings. (J Am Podiatr Med Assoc 103(6): 457–464, 2013)
Randomized trials must be of high methodological quality to yield credible, actionable findings. The main aim of this project was to evaluate whether there has been an improvement in the methodological quality of randomized trials published in the Journal of the American Podiatric Medical Association (JAPMA).
Randomized trials published in JAPMA during a 15-year period (January 1999 to December 2013) were evaluated. The methodological quality of randomized trials was evaluated using the PEDro scale (scores range from 0 to 10, with 0 being lowest quality). Linear regression was used to assess changes in methodological quality over time.
A total of 1,143 articles were published in JAPMA between January 1999 and December 2013. Of these, 44 articles were reports of randomized trials. Although the number of randomized trials published each year increased, there was only minimal improvement in their methodological quality (mean rate of improvement = 0.01 points per year). The methodological quality of the trials studied was typically moderate, with a mean ± SD PEDro score of 5.1 ± 1.5. Although there were a few high-quality randomized trials published in the journal, most (84.1%) scored between 3 and 6.
Although there has been an increase in the number of randomized trials published in JAPMA, there is substantial opportunity for improvement in the methodological quality of trials published in the journal. Researchers seeking to publish reports of randomized trials should seek to meet current best-practice standards in the conduct and reporting of their trials.
Background: Chronic plantar heel pain (CPHP) is common and is thought to have a detrimental impact on health-related quality of life. However, no study has used normative data or a control data set for comparison of scores. Therefore, we describe the impact of CPHP on foot-specific and general health-related quality of life by comparing CPHP subjects with controls.
Methods: Foot Health Status Questionnaire scores were compared in 80 subjects with CPHP and 80 sex- and age-matched controls without CPHP.
Results: The CPHP group demonstrated significantly poorer foot-specific quality of life, as evidenced by lower scores on the foot pain, foot function, footwear, and general foot health domains of the Foot Health Status Questionnaire. The group also demonstrated significantly poorer general health-related quality of life, with lower scores on the physical activity, social capacity, and vigor domains. In multivariate analysis, CPHP remained significantly and independently associated with Foot Health Status Questionnaire scores after adjustment for differences in body mass index. Age, sex, body mass index, and whether symptoms were unilateral or bilateral had no association with the degree of impairment in people with CPHP.
Conclusion: Chronic plantar heel pain has a significant negative impact on foot-specific and general health-related quality of life. The degree of negative impact does not seem to be associated with age, sex, or body mass index. (J Am Podiatr Med Assoc 98(4): 283–289, 2008)
Given the age-related decline in foot strength and flexibility, and the emerging evidence that foot problems increase the risk of falls, established guidelines for falls prevention recommend that older adults have their feet examined by a podiatrist as a precautionary measure. However, these guidelines do not specify which intervention activities might be performed. Published in this special issue of JAPMA are nine high-quality articles, including seven original studies and two basic science reviews, focusing on the benefit and impact of footwear and foot and ankle interventions in reducing the risk of falling. The selected studies discuss various relevant questions related to podiatric intervention, including adherence to intervention; preference and perception of older adults in selecting footwear; benefit of insoles, footwear, and nonslip socks in preventing falls; fear of falling related to foot problems; benefit of podiatric surgical intervention; and benefit of foot and ankle exercise in preventing falls. (J Am Podiatr Med Assoc 103(6): 452–456, 2013)