OAR@UM Community:

The effectiveness of orthotic insole materials for diabetic foot offloading : a systematic review

2026-07-14T09:52:57Z

Title: The effectiveness of orthotic insole materials for diabetic foot offloading : a systematic review Abstract: Review objectives: 'What is the effectiveness of different orthotic insole materials for diabetic foot offloading in reducing plantar pressure and improving biomechanical and clinical outcomes in adults living with diabetic peripheral neuropathy? 'To systematically evaluate the evidence on orthotic insole materials used for diabetic foot offloading, focusing on their biomechanical effectiveness, clinical outcomes, and relevance for the development of innovative insole materials.; The following questions will be investigated:; 1. How effective are commonly used orthotic insole materials, including EVA, Plastazote, PORON, polyurethane, gel, memory foam and viscoelastic materials, in reducing plantar pressure in adults with diabetic peripheral neuropathy?; 2. What effects do orthotic insole materials have on pressure–time integral, shear stress/forces, shock absorption and plantar pressure distribution in adults with diabetic peripheral neuropathy?; 3. What clinical outcomes are associated with the use of orthotic insoles in diabetic foot management, including ulcer prevention, ulcer recurrence, comfort, adherence and patientreported outcomes?; 4. What evidence exists regarding innovative orthotic insole materials, including non-Newtonian and adaptive polymers, and what knowledge gaps remain in their development and evaluation for diabetic foot offloading?

Supersonic shear wave elastography of human tendons is associated with in vivo tendon stiffness over small strains

2026-04-30T12:40:00Z

Title: Supersonic shear wave elastography of human tendons is associated with in vivo tendon stiffness over small strains Authors: Mifsud, Tiziana; Chatzistergos, Panagiotis; Maganaris, Constantinos; Chockalingam, Nachiappan; Padhiar, Nat; Micallef Stafrace, Kirill; Gatt, Alfred Abstract: Supersonic shear wave (SW) elastography has emerged as a useful imaging modality offering researchers and clinicians a fast, non-invasive, quantitative assessment of tendon biomechanics. However, the exact relationship between SW speed and in vivo tendon stiffness is not intuitively obvious and needs to be verified. This study aimed to explore the validity of supersonic SW elastography against a gold standard method to measure the Achilles tendon’s in vivo tensile stiffness by combining conventional ultrasound imaging with dynamometry. Twelve healthy participants performed maximal voluntary isometric plantarflexion contractions (MVC) on a dynamometer with simultaneous ultrasonographic recording of the medial gastrocnemius musculotendinous junction for dynamometry-based measurement of stiffness. The tendon’s force–elongation relationship and stress–strain behaviour were assessed. Tendon stiffness at different levels of tension was calculated as the slope of the stress–strain graph. SW speed was measured at the midportion of the free tendon and tendon Young’s modulus was estimated. A correlation analysis between the two techniques revealed a statistically significant correlation for small strains (r(10) = 0.604, p =.038). SW-based assessments of in vivo tendon stiffness were not correlated to the gold standard method for strains in the tendon>10 % of the maximum strain during MVC. The absolute values of SW-based Young’s modulus estimations were approximately-three orders of magnitude lower than dynamometry-based measurements. Supersonic SW elastography should be only used to assess SW speed for the detection and study of differences between tissue regions, differences between people or groups of people or changes over time in tendon initial stiffness (i.e., stiffness for small strains).

Elastography in the assessment of the Achilles tendon : a systematic review of measurement properties

2026-04-30T07:48:20Z

Title: Elastography in the assessment of the Achilles tendon : a systematic review of measurement properties Authors: Mifsud, Tiziana; Gatt, Alfred; Micallef‑Stafrace, Kirill; Chockalingam, Nachiappan; Padhiar, Nat Abstract: Background: Managing and rehabilitating Achilles tendinopathy can be difficult, and the results are often unsatisfactory. Currently, clinicians use ultrasonography to diagnose the condition and predict symptom development. However, relying on subjective qualitative findings using ultrasound images alone, which are heavily influenced by the operator, may make it difficult to identify changes within the tendon. New technologies, such as elastography, offer opportunities to quantitatively investigate the mechanical and material properties of the tendon. This review aims to evaluate and synthesise the current literature on the measurement properties of elastography, which can be used to assess tendon pathologies.; Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, PubMed, Cochrane, Scopus, MEDLINE Complete, and Academic Search Ultimate were searched. Studies assessing the measurement properties concerning reliability, measurement error, validity, and responsiveness of the instruments identified in healthy and patients with Achilles tendinopathy were included. Two independent reviewers assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology.; Results: Out of the 1644 articles identified, 21 were included for the qualitative analysis investigating four different modalities of elastography: axial strain elastography, shear wave elastography, continuous shear wave elastography, and 3D elastography. Axial strain elastography obtained a moderate level of evidence for both validity and reliability. Although shear wave velocity was graded as moderate to high for validity, reliability obtained a very low to moderate grading. Continuous shear wave elastography was graded as having a low level of evidence for reliability and very low for validity. Insufficient data is available to grade three-dimensional shear wave elastography. Evidence on measurement error was indeterminate so evidence could not be graded.; Conclusions: A limited number of studies explored quantitative elastography on Achilles tendinopathy as most evidence was conducted on a healthy population. Based on the identified evidence on the measurement properties of elastography, none of the different types showed superiority for its use in clinical practice. Further high-quality studies with longitudinal design are needed to investigate responsiveness.

A comparison between the 12-lead electrocardiogram and hand-held spectral waveform doppler ultrasound in the detection of atrial fibrillation (Master's dissertation).

2026-04-16T13:22:57Z

Title: A comparison between the 12-lead electrocardiogram and hand-held spectral waveform doppler ultrasound in the detection of atrial fibrillation (Master's dissertation). Abstract: Background: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia and a leading cause of thromboembolic stroke. Early detection is essential to initiate timely intervention and reduce associated morbidity and mortality. While electrocardiography (ECG) remains the gold standard for AF diagnosis, its routine use in community settings is limited. Pedal Doppler ultrasound (US) is already widely utilised in podiatric practice for vascular assessments, offering a potential opportunity for opportunistic AF screening during routine foot care. However, evidence quantifying the accuracy of pedal Doppler US for arrhythmia detection is limited. Aim: This study aimed to evaluate the accuracy of pedal Doppler US in identifying atrial fibrillation when compared with ECG findings, to determine its potential role as an opportunistic screening tool within podiatric practice. Methods: A cross-sectional study was conducted involving 112 participants aged 65 years and older. Pedal Doppler US was used to classify peripheral pulse patterns as regular, partially regular, or irregular. ECG served as the reference standard to confirm the presence or absence of arrhythmias. Chi-square analysis was employed to assess the association between Doppler findings and ECG results, and Cramér’s V was calculated to estimate effect size. Results: A strong, statistically significant association was found between Doppler-detected irregular pulses and ECG-confirmed arrhythmias (χ²(1, N=112)=52.42, p<0.001, Cramér’s V=0.68). Doppler US reliably identified all cases of irregularly irregular rhythms indicative of AF but failed to detect regular arrhythmias such as first-degree atrioventricular block and sinus bradycardia. Conclusion: Pedal Doppler US shows considerable promise as a rapid, non-invasive, and accessible preliminary screening tool for irregular arrhythmias in podiatric settings. With appropriate training to standardize interpretation, podiatrists could play a pivotal role in opportunistic AF detection, facilitating timely ECG referral and potentially reducing stroke incidence in at-risk populations. Larger-scale, multi-center studies are recommended to validate these findings and inform future clinical guidelines. Description: M.Sc.(Melit.)