OAR@UM Collection:

Lower limb biomechanical predictors of neuropathic ulceration in type II diabetes mellitus

Sat, 01 Jan 2022 00:00:00 GMT

Title: Lower limb biomechanical predictors of neuropathic ulceration in type II diabetes mellitus Abstract: Diabetes-related foot ulceration is a global leading cause of morbidity and mortality, with peripheral neuropathy being the most significant contributing factor. Research shows that plantar neuropathic ulceration does not necessarily occur on peak pressure areas and other underlying biomechanical factors might be playing a role during gait leading to tissue breakdown. The high prevalence of re-ulceration in patients with diabetic peripheral neuropathy (DPN) shows that current gold standard offloading interventions are not sufficient to prevent and treat ulcers. The purpose of this research was to identify the underlying biomechanical pathomechanism leading to tissue breakdown in the presence of DPN with the aim to propose more specific and individualised methods of ulcer healing and prevention. Four preliminary studies were conducted to provide the groundwork and inform the main quantitative cross-sectional research. The systematic review and meta-analysis results highlighted the significant lower limb musculoskeletal and plantar pressure changes occurring in DPN patients, however, high heterogeneity existed in literature. During Phase II, a mixed-methodological study was performed to explore the local lifestyle challenges met and the current clinical management of this patient population, where the need for a more in-depth biomechanical assessment and management emerged, including a multidisciplinary team of healthcare professionals. Subsequently, a prospective, observational pilot study recruiting 'healthy' participants has shown the significant influence of lower limb joint restriction on the duration of plantar loadings during gait rather than affecting peak pressures. The final preliminary inter-and intra-rater reliability study verifies that the measurements conducted during the main study could be reliably assessed by the researcher when using the formulated standardised protocol. During the main prospective, comparative, non-experimental research conducted in Phase IV, a total of eighty participants (57 male, 23 female, mean age 69.09 years [SD ±8.73], mean BMI 25.13 kg/m2 [SD ± 4.57] fit the inclusion/exclusion criteria and successfully participated in this study to form the four groups, namely; the type 2 diabetes (DM), diabetic peripheral neuropathy (DPN), diabetic neuropathic ulceration (DNU) and history of diabetic neuropathic ulceration (DHNU) groups. An integrated 3-D gait and plantar pressure analysis was performed to identify any significant changes in lower limb and foot joint kinematic, joint kinetic, plantar pressure (mean peak plantar pressure and pressure-time integral data) and spatiotemporal data during gait in the presence of diabetic peripheral neuropathy with or without active ulceration. Participants within the DNU and DHNU groups demonstrated significantly reduced knee and ankle joint dorsiflexion with resultant increased pelvic tilt and hip joint flexion. Significantly reduced kinematics in the shank/calcaneus and first metatarsal joint segments were also observed with resultant increased movement in the midtarsal joint segment. Finally, pressure-time integral data was significantly increased in active/history of forefoot ulceration sites, whereas mean peak plantar pressures were narrowly affected during gait. These findings led to the development of novel, biomechanical ulcer risk models and a clinical pathway as to the underlying pathomechanism leading to ulceration was proposed. Through the integration of a more individualised, biomechanical approach, this new knowledge may improve preventative and management strategies of ulceration, potentially reducing risk of tissue breakdown and amputation rates amongst the diabetic population. Description: Ph.D.(Melit.)

An evaluation of knowledge on different aspects of foot health in patients with rheumatoid arthritis

Sat, 01 Jan 2022 00:00:00 GMT

Title: An evaluation of knowledge on different aspects of foot health in patients with rheumatoid arthritis Abstract: Background: Foot problems are common in rheumatoid arthritis (RA), with physical pathologies manifesting in the feet and adversely impacting quality of life. An increasing amount of evidence supports effective management of foot problems in patients living with RA, with foot health education being acknowledged as a fundamental component in achieving good foot health. Aim: To evaluate knowledge amongst patients with RA on foot health, self-care practices, and the role of the podiatrist in foot care. Research Design and Method: A single-centre, non-experimental prospective study design was conducted on 52 Maltese patients living with RA attending the specialised rheumatology clinic within the podiatry clinic at Birkirkara Health Centre. Participants aged 18 or over with RA score of 6 or higher according to the 2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for RA were recruited in the study. The “Education for podiatric health in patients with rheumatoid arthritis No questionnaire” was utilised to evaluate knowledge on foot health in RA patients. Results: Participants in this study were knowledgeable on certain aspects related to foot health, however, areas of knowledge deficit were: proper toenail trimming, knowledge related to foot deformities, falls, and difficulty in ambulation due to RA. With regards to the role of the podiatrist in foot health, most participants were aware that podiatrist perform toenail trimming, and remove hyperkeratotic lesions, however certain participants were unfamiliar with other roles of the podiatrist. As regards to patients’ measures when experiencing foot pain responses ranged from conservative treatments at home, to reaching out to health professionals. A sub-analysis of the study showed a correlation between aspects of self-care and gender, between knowledge on the repercussion of RA on feet and level of education, and between aspects of self-care and level of education. Age, marital status, duration of RA, and attendance to a foot health educational programme showed no correlation. Conclusion: The knowledge deficits identified in this study indicate the necessity of foot health educational sessions to be implemented for the RA population. Further research in different settings such as in rheumatology clinics which do not operate within the podiatry centre could be essential in evaluating knowledge on foot health amongst patients with RA. Description: B.Sc. (Hons)(Melit.)

An investigation of weight transfer amongst amateur golfers with different foot postures during golf swing

Sat, 01 Jan 2022 00:00:00 GMT

Title: An investigation of weight transfer amongst amateur golfers with different foot postures during golf swing Abstract: Background: Golf is one of the most popular sports around the world attracting a variety of people. However, several factors including poor swing mechanics can predispose one to golf-related injuries. Golf coaching literature has brought out the importance of performing the proper weight transfer pattern, this is, the shift from one foot to another, during golf swing. Research has shown different weight transfer patterns according to different variables such as skill level and golf clubs however, none have investigated weight transfer patterns according to physical attributes of a golfer such as his foot posture. It is known that foot postures alter dynamic activities due to structural differences however, it is not yet known how they can affect sports performance. Therefore, knowing if foot postures affect weight transfer during golf swing may be beneficial for the golfing community in terms of injury prevention and performance enhancement. Aim: The aim of this study was to investigate the correlation between foot posture and weight transfer during golf swing. Research Design and Method: A prospective non-experimental descriptive correlation study was conducted at the Biomechanics Lab at the Faculty of Health Sciences, University of Malta. Amateur golfers from the Royal Malta Golf Club were enrolled in this study. The Foot Posture Index-6 was performed on each participant and were grouped accordingly prior to performing 10 suitable golf swings with a 7-iron. Each foot placed on an AMTI ©,force plate embedded in a ten-meter walkway to measure ground reaction forces. Each component of the ground reaction forces was noted at 10 different golf swing events which were segregated using a 100Hz camera placed at a 90-degree angle showing the frontal plane motion of the golfer during golf swing. These results obtained were evaluated according to foot posture, age, and handicap group. Results: Significant differences were found (p<0.05) in the vertical component of both feet during early downswing between different age groups with varied foot postures. In addition, the vertical component and the medio-lateral component of the left foot were significantly different during early downswing and ball impact, respectively, between golfers of different age groups (over 55 and under 55 years of age). The same significant differences were found on the right foot between golfers of different age groups with the addition of the anterior-posterior component during early downswing. Conclusion: Age and foot posture together affect the ground reaction forces during golf swing in amateur golfers. This can be due to the physiological changes one experiences as one ages. Since the magnitude and direction of the ground reaction forces as well as weight transfer are important factors in golfing performance, this kinetic data should be considered to improve performance and promote participation in golf in later life. Description: B.Sc. (Hons)(Melit.)

The effect of electronic reminders on patients' adherence to topical emollient in patients with foot xerosis

Sat, 01 Jan 2022 00:00:00 GMT

Title: The effect of electronic reminders on patients' adherence to topical emollient in patients with foot xerosis Abstract: Background: Medication adherence serves a very important role in the management of medical conditions, since it is one of the main factors that determines successful treatment outcomes. Medication non-adherence to topical treatment is reported to occur in up to 50% of the population, with a negative impact on the patient’s medical condition. Preventing this from occurring is vital in order to reduce patient hospitalization and related complications. Therefore, because of the negative impact that medical non-adherence can have on both the patient and health economics, non-adherence should be considered as a major public health concern and should be further investigated in order to find ways to reduce non-adherence to medication and increase successful treatment outcomes. Aim: The main aim of the study was to determine whether daily electronic reminders are an effective means of increasing medical adherence to topical treatment in patients with xerosis. Research Design: A cohort of 47 participants which fit the inclusion and exclusion criteria were recruited from the Community Health Centres (Paola & Mosta Health Centres). Participants were randomly allocated in a 1:1 ratio to either the experiment group or control group. Participants in the experiment group were provided with an emollient and received daily electronic reminders whilst the participant in the control group were only provided with the emollient. The participants’ xerotic skin was analysed using a foot xerosis scale and a digital moisture monitor. These reading were taken at baseline and after the 4-week study period. Results: It was noted that participants from both groups had significant improvements in their percentage skin hydration and xerosis score (p=0.00). Furthermore, when the results of both groups were compared, a significant difference was present between the two groups (p=0.00), indicating that the experiment group had higher mean percentage scores. Conclusion: In conclusion, the finding of this study show that daily electronic reminders are an effective, customizable and cheap means of improving medication adherence to topical treatment. Electronic reminders along with other interventions, if applied within the community, may be key in addressing the problem of medication non-adherence. Description: B.Sc. (Hons)(Melit.)