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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.)

The evolving field of mobile applications : a smarter approach to diabetic foot ulcer measurement

2026-04-14T12:16:14Z

Title: The evolving field of mobile applications : a smarter approach to diabetic foot ulcer measurement Abstract: Aim: This study evaluates the inter-rater reliability of diabetic foot ulcer (DFU) measurement using the traditional paper-ruler method versus the Imito Wound Application. Given the clinical importance of accurate and reproducible ulcer measurement, the research aims to determine whether a smartphone-based application offers a more reliable alternative to standard care, thereby improving DFU prognosis and management. Research Design and Method: A comparative observational study was conducted involving clinicians measuring DFUs using both the paper-ruler method and the Imito Wound App. A total of 67 DFUs were assessed, with each ulcer measured independently by three raters using both methods. The inter-rater reliability was analyzed using intraclass correlation coefficients (ICC), and statistical assessments were performed using SPSS software. Additional analyses considered the impact of ulcer shape and location on measurement reliability. Results: The results have highlighted that measurements performed by the ruler method have a difference by 1.43 times across all raters when compared to the Imito Application results. The ICC of both measurements was very good, with Imito App having a slightly better interrater reliability that of ICC- 0.975 vs ICC of 0.970 for the Ruler measurements. Ulcer shape and location influenced reliability, with irregularly-shaped DFUs exhibiting greater measurement discrepancies in the ruler method. Conclusion: The findings underscore the limitations of the paper-ruler method and support the use of smartphone-based wound measurement tools for DFU assessment. The Imito Wound App significantly enhances measurement reliability, reducing inconsistencies that could impact treatment decisions by the introduction of a more objective measuring tool. Integrating digital wound measurement into clinical practice could improve DFU monitoring, ultimately reducing the risk of complications and lower limb amputations. Description: M.Sc.(Melit.)

Foot orthoses for forefoot pressure reduction and the hypothesized role in calf muscle stretching : a systematic review highlighting an evidence gap

2026-04-13T09:46:50Z

Title: Foot orthoses for forefoot pressure reduction and the hypothesized role in calf muscle stretching : a systematic review highlighting an evidence gap Authors: Thiaspras, Loukas; Formosa, Cynthia; Papanas, Nikolaos; Gatt, Alfred Abstract: Background: Excessive forefoot plantar pressures are associated with pain, ulceration risk, and functional limitations in both healthy individuals and those with pathologies such as rheumatoid arthritis (RA). Limited ankle dorsiflexion, often related to gastrocnemius–soleus tightness, may contribute to forefoot overload. Although foot orthoses (FOs) are widely used to redistribute plantar loads, it remains unclear whether the existing evidence includes orthotic interventions designed to promote posterior chain flexibility.; Objective: To systematically evaluate the effectiveness of foot orthoses in reducing forefoot plantar pressure and pressure-time integral (PTI), and to identify whether current evidence addresses orthoses specifically intended to facilitate calf muscle stretching.; Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Five databases were searched up to December 2024. Inclusion criteria encompassed adult populations, studies reporting plantar pressure outcomes, and interventions involving foot orthoses. Methodological quality was assessed using RoB 2 and ROBINS-I tools. Due to substantial clinical and methodological heterogeneity, a meta-analysis was not undertaken and findings were synthesized narratively.; Results: Twelve studies involving 456 participants met the inclusion criteria. No eligible studies directly evaluated orthoses designed to stretch the triceps surae. All included studies reported reductions in peak plantar pressure (PPP) and/or pressure-time integral (PTI). Descriptively, PPP reductions were greater in healthy cohorts (unweighted mean 20.2%) compared to RA populations (14.5%), whereas PTI reductions were descriptively higher in RA participants (22.2% vs. 14.7%). Interventions incorporating metatarsal pads and soft contoured orthoses showed consistent reductions in forefoot loading across studies.; Conclusions: Foot orthoses appear to be consistently associated with reductions in forefoot plantar loading across populations, particularly in individuals with inflammatory or structural pathology. The absence of studies specifically evaluating posterior chain flexibility represents a clear evidence gap. Future research should explore whether orthotic designs combining forefoot offloading with mechanisms that may influence ankle dorsiflexion or posterior chain mechanics could have biomechanical relevance.

An innovative treatment using sterile hyaluronic acid injections to reduce foot ulcer recurrence in patients with diabetes : a pilot study

2026-04-10T09:47:01Z

Title: An innovative treatment using sterile hyaluronic acid injections to reduce foot ulcer recurrence in patients with diabetes : a pilot study Authors: Hughes, Catherine; Papanas, Nikolaos; Formosa, Cynthia Abstract: To evaluate whether plantar injection of hyaluronic acid using the Curacorn® technique can reduce ulcer recurrence in high-risk patients with diabetes. This pilot study included 14 patients with type 2 diabetes and a history of recurrent healed neuropathic or Charcot-related plantar foot ulcers. All ulcers were healed for at least 4 weeks prior to inclusion. Patients underwent 3-4 treatment sessions using a sterile, cross-linked hyaluronic acid gel implanted beneath previous ulcer sites. They were followed for 6–12 months to assess ulcer recurrence. Seven patients (50%) experienced no ulcer recurrence during the follow-up period of the study. Patients without recurrence received a higher total volume of hyaluronic acid when compared with those who experienced recurrence (mean 7.4 ml vs 3.9 ml). Ulcer recurrence in the remaining patients occurred after an initial ulcer-free period of approximately six months. In this pilot cohort, hyaluronic acid injection using the Curacorn® technique was associated with a reduction in ulcer recurrence, particularly when adequate gel volumes were administered. These findings support further investigation of this minimally invasive approach as a preventive strategy in high-risk diabetic foot patients.