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Objective: Ultrasound (US) imaging may play a fundamental role in the earlier detection and assessment of first metatarsophalangeal joint (MTPJ) osteoarthritis (OA) because of its ability to depict tissue‐specific morphologic changes before the point of irreversible structural damage. However, the role of US in supporting the diagnosis of OA in foot joints has not been clearly defined. The aims of this study were to develop a semiquantitative US atlas (the AUT ultrasound imaging [AUTUSI] atlas) to grade the degree of osteoarthritic change in the first MTPJ and to evaluate the intraexaminer and interexaminer reproducibility of using the atlas. Methods: US images were obtained from 57 participants (30 participants with radiographically confirmed first MTPJ OA). The AUTUSI atlas supports the examination of grading joint effusion, synovial hypertrophy, synovitis, osteophytes, joint space narrowing, and cartilage thickness. Six examiners used the atlas to independently grade 24 US images across 2 sessions. Intraexaminer and interexaminer reproducibility were determined using percentage agreement and Gwet's AC2. Results: Observations using the AUTUSI atlas demonstrated almost perfect‐to‐perfect interexaminer agreement (percentage agreement ranged from 96% to 100%, and Gwet's AC2 values ranged from 0.81 to 1.00) and moderate‐to‐perfect intraexaminer agreement (percentage agreement ranged from 67% to 100%, and Gwet's AC2 values ranged from 0.54 to 1.00). Conclusion: The AUTUSI atlas demonstrated excellent intraexaminer and interexaminer reproducibility for evaluating first MTPJ joint effusion, synovial hypertrophy, synovitis, joint space narrowing, osteophytes, and cartilage thickness. The AUTUSI atlas affords an opportunity to detect prognostic markers of OA earlier in the disease cascade and has the potential to advance understanding of the pathologic process of first MTPJ OA. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to examine the incidence and progression of foot osteoarthritis (OA), as well as associated factors, in a community-based cohort. Methods: Baseline (2013–2015) and follow-up (2016–2018) foot radiographs were available for 541 participants (71% women, mean age 69 years; 35% black, 53% with obesity). The LaTrobe Foot Atlas was used to examine osteophytes (OPs, score 0–3) and joint space narrowing (JSN, score 0–3) at 5 joint sites. Incident foot radiographic OA (rOA) was a baseline score <2 OP and JSN in all 5 joints with ≥2 OP or JSN at follow-up in any of the joints. Progression was a worsening OP or JSN score in a joint with baseline foot rOA. At baseline and follow-up, participants reported the presence/absence of foot symptoms and completed the Foot and Ankle Outcome Score (FAOS) for each foot. Joint-based logistic regression models with generalized estimating equations were used to examine associations (adjusted odds ratio [aOR], 95% confidence interval [CI]) of foot rOA incidence and progression and with covariates. Results: Among 928 feet without baseline rOA, 4% developed incident foot rOA (2% of those developed symptoms). Among 154 feet with baseline foot rOA, 55% had radiographic progression (16% of those had symptoms). Women and those with higher body mass index (BMI) were more likely to have incident foot rOA (aOR [95% CI] = 4.10 [1.22, 13.8] and 1.60 [1.31, 1.97], respectively); history of gout was associated with incidence or progression of foot rOA (2.75 [1.24, 6.07]). BMI was associated with worse scores on all FAOS subscales (aORs range 1.21–1.40). Conclusion: Progression of foot rOA is common but not necessarily related to worsening symptoms. BMI may be a modifiable risk factor for foot OA. [ABSTRACT FROM AUTHOR]

Introduction: Foot pain can be a significant burden for patients. Custom foot orthoses (CFOs) have been a mainstay in podiatry treatment for foot pain management and improving foot function. However, little is known about podiatrists' experience of prescribing CFOs or patient experience of using foot orthoses (FOs), including CFOs, for foot pain. Methods: A focus group (FG) discussion with three FOs users (Female = 2 and Male = 1) was conducted in November 2022 within a private podiatry practice. This group represented non‐experts from the general local population of individuals with existing or previous foot pain who have personally experienced using either over‐the‐counter FOs or CFOs. An online FG discussion with five musculoskeletal (MSK) specialist podiatrists (Female = 2 and Male = 3) was also conducted in December 2022. This group represented podiatrists with specialist knowledge in foot biomechanics and clinical experience in CFO provision. The FG discussions were recorded and lasted 49 and 57 min respectively. Transcribed data was manually coded, and a thematic analysis was undertaken to identify patterns within the collected data. Results: The participants in the patient FG detailed mixed experiences of the prescription process and CFOs received, with reports of limited involvement/input in their prescription, the need for frequent adjustments and high costs. The impact on footwear choices, replicability and transferability of CFOs into different types of shoes and technologies to aid design were also highlighted. In the podiatrist FG, lack of confidence in design and manufacture processes, prescription form language, relationship and communication building with manufacturers, variability in the CFOs issued and the need for better student education in CFO provision emerged as key themes. Conclusion: Patients and podiatrists shared similar views on CFO provision, namely poor communication with manufacturers leading to dissatisfaction with the CFOs prescribed causing negative impacts on patient experiences. Podiatrists called for greater education at registration level to increase new graduate podiatrist knowledge in CFO design and manufacture and better collaboration with manufacturing companies. [ABSTRACT FROM AUTHOR]

The aim of this research was to describe the epidemiology, presentation and healthcare use in primary care for foot and ankle problems in children and young people (CYP) across England. We undertook a population-based cohort study using data from the Clinical Practice Research Datalink Aurum database, a database of anonymised electronic health records from general practices across England. Data was accessed for all CYP aged 0–18 years presenting to their general practitioner between January 2015 and December 2021 with a foot and/or ankle problem. Consultation rates were calculated and used to estimate numbers of consultations in an average practice. Hierarchical Poisson regression estimated relative rates of consultations across sociodemographic groups and logistic regression evaluated factors associated with repeat consultations. A total of 416,137 patients had 687,753 foot and ankle events, of which the majority were categorised as "musculoskeletal" (34%) and "unspecified pain" (21%). Rates peaked at 601 consultations per 10,000 patient-years among males aged 10–14 years in 2018. An average practice might observe 132 (95% CI 110 to 155) consultations annually. Odds for repeat consultations were higher among those with pre-existing diagnoses including juvenile arthritis (OR 1.73, 95% CI 1.48 to 2.03). Conclusions: Consultations for foot and ankle problems were high among CYP, particularly males aged 10 to 14 years. These data can inform service provision to ensure CYP access appropriate health professionals for accurate diagnosis and treatment. What is Known: • Foot and ankle problems can have considerable impact on health-related quality of life in children and young people (CYP). • There is limited data describing the nature and frequency of foot and ankle problems in CYP. What is New: • Foot and ankle consultations were higher in English general practice among CYP aged 10 to 14 years compared to other age groups, and higher among males compared to females. • The high proportion of unspecified diagnoses and repeat consultations suggests there is need for greater integration between general practice and allied health professionals in community-based healthcare settings. [ABSTRACT FROM AUTHOR]

Objective: The metatarsophalangeal joints (MTPJs) are the most common location for synovitis in people with rheumatoid arthritis (RA), yet their association with plantar foot pressures has received very little attention. This study aimed to determine whether plantar pressures differed based on sonographic evidence of MTPJ synovitis in people with RA. Method: Ultrasound was used to assess synovitis (grey scale synovial hypertrophy and power Doppler signal) in MTPJs 1 to 5 using the combined EULAR/Outcome Measures in Rheumatology scoring system. Peak pressure (PP) and pressure time integrals (PTIs) were assessed during barefoot walking for seven plantar foot regions (heel, midfoot, first metatarsal, second metatarsal, third to fifth metatarsals, hallux, lesser toes). Mixed‐effects linear regression was used to determine the difference in PP and PTI between MTPJs with none/minimal synovitis and MTPJs with moderate/severe synovitis. Results: Thirty‐five participants with RA were included. Mean age was 66.3 years and mean disease duration was 22.2 years. Participants with sonographic evidence of moderate/severe synovitis at the first MTPJ had reduced PTI at the hallux compared with those with none/minimal synovitis at this joint (P = 0.039). Participants with moderate/severe synovitis at the second MTPJ and fourth MTPJ had reduced PP and reduced PTI at lesser toes compared with those with none/minimal synovitis in these joints (all P ≤ 0.048). No significant differences were observed for synovitis in other joints. Conclusion: These findings may be suggestive of an inverse relationship between plantar pressure and soft tissue pathology, which is consistent with an offloading strategy and reduced use of the toes during propulsion. [ABSTRACT FROM AUTHOR]

Objective: Given the ability of ultrasound imaging (USI) to depict tissue‐specific morphological changes before the onset of pain and before the point of irreversible structural damage, USI could play a fundamental role in earlier detection and assessment of foot osteoarthritis (OA). The current guidelines require further refinement of anatomical landmarks to establish a standardized imaging procedure to improve the interpretability and reproducibility between studies evaluating the first metatarsophalangeal joint (MTPJ). The aims were to develop an USI acquisition procedure and grading system to examine OA features in the first MTPJ and to determine intra‐examiner and inter‐examiner reliability of a newly developed USI acquisition procedure. Design: Thirty participants with first MTPJ OA confirmed radiographically with the use of the La Trobe Foot Atlas were included. An experienced sonographer applied a newly developed USI procedure to examine the following features: joint effusion, synovial hypertrophy, synovitis, joint space narrowing, osteophytes, and cartilage thickness. A semiquantitative grading system was applied to all features. A continuous measure was also examined for osteophyte size, joint space narrowing, and cartilage thickness. To determine the intra‐examiner and inter‐examiner reliability, an experienced radiologist and sonographer applied the developed grading system to the images acquired from two imaging sessions. Intra‐examiner and inter‐examiner reliability were calculated using intraclass correlation coefficients (ICCs). Results: ICCs for intra‐examiner between session reliability ranged from 0.58 to 0.92 for semiquantitative grading and 0.39 to 0.94 for continuous measures. Joint effusion and osteophytes achieved the highest intra‐examiner reliability (ICC = 0.78–0.94). ICCs for session one inter‐examiner reliability ranged from 0.61 to 1.0 for semiquantitative grading; all continuous measures had an ICC of 1. ICCs for session two inter‐examiner reliability ranged from 0.55 to 1.0 for semiquantitative grading and 0.9 to 0.97 for continuous measures. Inter‐examiner reliability was good for grading joint effusion (ICC = 0.55–0.62) and was excellent for all other USI features (ICC = 0.77–1.0). Conclusion: The USI acquisition procedure and grading system are reliable in evaluating first MTPJ OA features in participants with radiologically confirmed OA. The study will inform the methodological development of an ultrasound atlas for grading the degree of osteoarthritic change in the first MTPJ. [ABSTRACT FROM AUTHOR]

Objectives: Earlier studies suggest that being married in later life protects against dementia, and that being single in old age increases the risk of dementia. In this study, we examine midlife marital status trajectories and their association with dementia and mild cognitive impairment (MCI) at ages 70 plus using a large population based sample from Norway. Methods: Based on a general population sample linked to population registries (N = 8706), we used multinomial logistic regression to examine the associations between six types of marital trajectories (unmarried, continuously divorced, intermittently divorced, widowed, continuously married, intermittently married) between age 44 and 68 years from national registries and a clinical dementia or a MCI diagnosis after age 70. We estimated relative risk ratios (RRR) and used mediation analyses adjusting for education, number of children, smoking, hypertension, obesity, physical inactivity, diabetes, mental distress, and having no close friends in midlife. Inverse probability weighting and multiple imputations were applied. The population attributable fraction was estimated to assess the potential reduction in dementia cases due to marital histories. Results: Overall, 11.6% of the participants were diagnosed with dementia and 35.3% with MCI. Dementia prevalence was lowest among the continuously married (11.2%). Adjusting for confounders, the risk of dementia was higher for the unmarried (RRR = 1.73; 95% CI: 1.24, 2.40), continuously divorced (RRR = 1.66; 95% CI: 1.14, 2.43), and intermittently divorced (RRR = 1.50; 95% CI: 1.09, 2.06) compared to the continuously married. In general, marital trajectory was less associated with MCI than with dementia. In the counterfactual scenario, where all participants had the same risk of receiving a dementia diagnosis as the continuously married group, there would be 6.0% fewer dementia cases. Discussion: Our data confirm that staying married in midlife is associated with a lower risk of dementia and that divorced people account for a substantial share of dementia cases. [ABSTRACT FROM AUTHOR]

To explore footwear characteristics and foot problems in community dwelling people with stroke as most research to date focused on the general elderly population. Thirty people with mild to moderate stroke (nine men, mean age 68, mean time since onset 67 months) attended a single session to assess footwear and foot problems using established podiatry foot (wear) and ankle assessments. Most participants wore slippers indoors (n = 17, 57%) and walking shoes outdoors (n = 11, 37%). Over half wore unsupportive ill-fitting shoes indoors and 47% of outdoor shoes fitted badly. All participants had foot problems (mean 6.5 (3.1), 95% CI: 5.4–7.7), including impaired single limb heel raise (93%), reduced range of movement (77%), sensation (47%), and muscle strength (43%). Many had foot-pain, hallux valgus (both 50%), or swollen feet (40%). Foot problems were associated with reduced balance confidence, activity, and community participation (all p < 0.05). A greater proportion of fallers (13/16) than non-fallers (4/14) reported foot problems (p = 0.029). Many community-dwelling people with stroke wore poorly fitting shoes; all had foot problems. Foot problems were linked to reduced mobility. Finding more effective pathways to support people with stroke to select supportive, well-fitting indoor and outdoor footwear is indicated. People with stroke often wear unsupportive ill-fitting shoes and experience foot problems. Assessment of foot problems and footwear advice should be considered during stroke rehabilitation particularly when interventions target fall prevention or improvements in balance and mobility. Information on appropriate footwear and signposting that new shoe purchases should include measuring feet to ensure a good fit is recommended. [ABSTRACT FROM AUTHOR]

Background: The UK medicines legislation was amended ten years ago (2013) to allow podiatrists and physiotherapists independent prescribing rights, the first of the allied health professions to do so. Non-medical prescribing formed one part of a broader policy agenda promoting role flexibility in response to the challenge of an ageing population and the need to maintain effective health provision in the face of a contracting workforce. Aim: The aim of this study was to outline the experiences of the Department of Health AHP medicines project board team in working towards independent prescribing for podiatry and physiotherapy, with a particular focus on the challenges encountered. Methods: In depth, open-ended interviews were conducted with eight of the core members of the project team, drawn from those individuals who served throughout the duration of the project (2010–2013). Included were the former Department of Health Chief and Deputy Chief Allied Health Professions Officers; the Department of Health Engagement and Communications Officer; representatives of the Health and Care Professions Council; the Medicines and Healthcare products Regulatory Agency; the Council of Deans of Health; the Royal College of Podiatry and the Chartered Society of Physiotherapy (The team also included the representative of the Allied Health Professions Federation. However, as that representative is also a researcher in this study, he has recused himself from any role as a participant.). Data were transcribed and subject to a thematic analysis. Results: A complex picture of the project emerged revealing a range of obstacles and challenges, including inter-professional role boundary tensions and negative prior assumptions about the two professions. Success hinged upon the adoption of a dual strategy involving submission of a robust case of need focused on patient benefit coupled with the careful management of professional expectations. Underpinning theory from the sociology of the professions offers a supportive explanatory framework for understanding the relationships between the various stakeholders involved. Conclusions: Ultimately, success depended upon aligning the project aims with healthcare policy through a clear focus on patient benefit. Balancing competing professional and policy demands through a continual emphasis on improved patient care laid the foundations for future projects by other allied health professions. [ABSTRACT FROM AUTHOR]

Background: Research shows that retirement age is associated with later‐life cognition but has not sufficiently distinguished between retirement pathways. We examined how retirement age was associated with later‐life dementia and mild cognitive impairment (MCI) for people who retired via the disability pathway (received a disability pension prior to old‐age pension eligibility) and those who retired via the standard pathway. Methods: The study sample comprised 7210 participants from the Norwegian Trøndelag Health Study (HUNT4 70+, 2017–2019) who had worked for at least one year in 1967–2019, worked until age 55+, and retired before HUNT4. Dementia and MCI were clinically assessed in HUNT4 70+ when participants were aged 69–85 years. Historical data on participants' retirement age and pathway were retrieved from population registers. We used multinomial regression to assess the dementia/MCI risk for women and men retiring via the disability pathway, or early (<67 years), on‐time (age 67, old‐age pension eligibility) or late (age 68+) via the standard pathway. Results: In our study sample, 9.5% had dementia, 35.3% had MCI, and 28.1% retired via the disability pathway. The disability retirement group had an elevated risk of dementia compared to the on‐time standard retirement group (relative risk ratio [RRR]: 1.64, 95% CI 1.14–2.37 for women, 1.70, 95% CI 1.17–2.48 for men). MCI risk was lower among men who retired late versus on‐time (RRR, 0.76, 95% CI 0.61–0.95). Conclusion: Disability retirees should be monitored more closely, and preventive policies should be considered to minimize the dementia risk observed among this group of retirees. Key points: In many countries, a significant proportion of people exit the workforce before they are eligible to receive an old‐age pension due to disability.In a Norwegian population‐based cohort study (based on the HUNT Study linked to population registry data), we found that early retirement due to disability—but not early retirement per se—was associated with a higher risk of dementia in later life.The cognitive health of people exiting the workforce due to disability should be monitored.Studies researching the link between retirement age and later‐life cognition should distinguish between different pathways to retirement. [ABSTRACT FROM AUTHOR]

Objectives: Temporal and global changes in research utilising imaging to assess foot osteoarthritis is currently unknown. This study aimed to undertake a bibliometric analysis of published research to: (1) identify the imaging modalities that have been used to evaluate foot osteoarthritis; (2) explore the temporal changes and global differences in the use of these imaging modalities; and (3) to evaluate performance related to publication- and citation-based metrics. Methods: A literature search was conducted using Scopus to identify studies which had used imaging to assess foot osteoarthritis. Extracted data included publication year, imaging modality, citations, affiliations, and author collaboration networks. Temporal trends in the use of each imaging modality were analysed. Performance analysis and science mapping were used to analyse citations and collaboration networks. Results: 158 studies were identified between 1980 and 2021. Plain radiography was the most widely used modality, followed by computed tomography, magnetic resonance imaging (MRI) and ultrasound imaging (USI), respectively. The number of published studies increased over time for each imaging modality (all P ≥ 0.018). The most productive country was the United States of America (USA), followed by the United Kingdom and Australia. International authorship collaboration was evident in 57 (36.1%) studies. The average citation rate was 23.4 per study, with an average annual citation rate of 2.1. Conclusions: Published research employing imaging to assess foot osteoarthritis has increased substantially over the past four decades. Although plain radiography remains the gold standard modality, the emergence of MRI and USI in the past two decades continues to advance knowledge and progress research in this field. [ABSTRACT FROM AUTHOR]

Background: Ankle arthroplasty, commonly known as ankle replacement, is a surgical procedure for treating end-stage ankle osteoarthritis. Whilst evidence shows good clinical results after surgery, little is known of the long-term survival of ankle replacements and the need for ankle revision. Using more recent implant data and long-term data, there is now opportunity to examine at a population-level the survival rate for ankle implants, to examine between-country differences in ankle revision surgery, and to compare temporal trends in revision rates between countries. Methods: Four national joint registries from Australia, New Zealand, Norway and Sweden provided the necessary data on revision outcome following primary ankle replacement, for various periods of observation – the earliest starting in 1993 up to the end of 2019. Data were either acquired from published, online annual reports or were provided from direct contact with the joint registries. The key information extracted were Kaplan-Meier estimates to plot survival probability curves following primary ankle replacement. Results: The survival rates varied between countries. At 2 years, across all registries, survival rates all exceeded 0.9 (range 0.91 to 0.97). The variation widened at 5 years (range 0.80 to 0.91), at 10 years (range 0.66 to 0.84) and further at 15-years follow-up (0.56 to 0.78). At each time point, implant survival was greater in Australia and New Zealand with lower rates in Sweden and Norway. Conclusions: We observed variation in primary ankle replacement survival rates across these national registries, although even after 5 years, these population derived data show an 80% revision free survival. These data raise a number of hypotheses concerning the reasons for between-country differences in revision-free survival which will require access to primary data for analysis. [ABSTRACT FROM AUTHOR]

Background: Ankle arthroplasty, commonly known as ankle replacement, is a surgical procedure for treating end-stage ankle osteoarthritis. Whilst evidence shows good clinical results after surgery, little is known of the long-term survival of ankle replacements and the need for ankle revision. Using more recent implant data and long-term data, there is now opportunity to examine at a population-level the survival rate for ankle implants, to examine between-country differences in ankle revision surgery, and to compare temporal trends in revision rates between countries. Methods: Four national joint registries from Australia, New Zealand, Norway and Sweden provided the necessary data on revision outcome following primary ankle replacement, for various periods of observation – the earliest starting in 1993 up to the end of 2019. Data were either acquired from published, online annual reports or were provided from direct contact with the joint registries. The key information extracted were Kaplan-Meier estimates to plot survival probability curves following primary ankle replacement. Results: The survival rates varied between countries. At 2 years, across all registries, survival rates all exceeded 0.9 (range 0.91 to 0.97). The variation widened at 5 years (range 0.80 to 0.91), at 10 years (range 0.66 to 0.84) and further at 15-years follow-up (0.56 to 0.78). At each time point, implant survival was greater in Australia and New Zealand with lower rates in Sweden and Norway. Conclusions: We observed variation in primary ankle replacement survival rates across these national registries, although even after 5 years, these population derived data show an 80% revision free survival. These data raise a number of hypotheses concerning the reasons for between-country differences in revision-free survival which will require access to primary data for analysis. [ABSTRACT FROM AUTHOR]

Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected older adults. Despite calls to include older people in societal decision making, the extent to which older adults have participated in the pandemic-related public debate is unknown. This study investigated older adults' (65+ years) voice and visibility as guests on political talk shows as an important arena of public debate. Specifically, we examined how often older adults appeared as guests, their characteristics, and how older versus younger guests discussed the pandemic. Research Design and Methods Judges assessed all guests' age, gender, migration experience, functional aids, and professional background on all episodes of the 4 most-watched political talk shows in Germany between January 1 to December 31, 2020 (N = 136 episodes, K = 754 guests). We used an exploratory sequential mixed-methods approach and frame analysis on all episodes featuring older guests (n = 37), to first identify how guests discussed the pandemic, and then assess differences in positions between older and younger guests (<65 years). Results Older guests rarely appeared (12.2% of all guests, 9.6% of guests on COVID-related episodes) and if they did, they were majorly male, young-old, German-born professionals with no functional aids. Rather than appearing as "peer advocates" of older adults, older guests framed the pandemic similarly to younger guests, with a tendency to more strongly address disproportionate restrictions of civil liberties in society. Discussion and Implications Results suggest that one prominent part of German media failed to represent the diverse voice of a population most affected by the COVID-19 pandemic in 2020. Differences between how older and younger guests discussed the pandemic may reflect their privileged background in addition to generational differences in attitudes toward government. Future research in other social fora and of other social groups of older adults might facilitate understanding how older adults shaped the public debate on the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Aims: Currently, wound management decisions are based largely on visual observations such as photographs, descriptors or measurements which can lack detail and do not always capture the sub-wound area. A previous case series suggests that there is benefit in using ultrasound imaging (USI) to evaluate diabetic foot ulcers (DFU) at point-of-care, however no guidance exists to inform its use. This scoping exercise explores the capacity of podiatrists with experience in interpreting musculoskeletal structures using USI to interpret sonographic images of DFU. Methods: Following a short briefing session, podiatrists with previous musculoskeletal (MSK) USI training were asked to review and report on previously recorded static sonographic images (n = 8) of active DFU. Content analysis was utilised to identify recurring keywords within the podiatrists' reports which were coded and assigned to categories to gain context to the data. Results: Seven podiatrists participated in the study. Four categories were constructed for the purposes of analysis: Frequency of reporting, 2) Language used in reporting, 3) Observations, 4) Clinical impression Frequently, the reported findings between podiatrists were found to be similar, especially those related to bone morphology. However greater variability was seen in the reporting of wound specific soft-tissue observations. Conclusion: This scoping exercise has shown that podiatrists can translate their existing USI skills to make rudimentary reports on clinical findings in DFU. All participants were consistently able to identify and describe characteristics associated with DFU from a single b mode static wound ultrasound image. Findings from this investigation can be used as a foundation for further work to establish accuracy and reliability to validate DFU sonography. In conjunction the development of protocols and training materials will enable the adoption of USI to assess DFU in clinical practice. This will in turn, contribute to improved patient care and establish a new paradigm for wound surveillance which is translatable to other wound types. [ABSTRACT FROM AUTHOR]

Objective: Our aims were to examine the effects of heeled shoes on incident knee osteoarthritis (OA) and joint pain. Methods: We used longitudinal data from the Chingford 1000 Women Study (Chingford Study), a prospective cohort of women aged 50 years or older. Participants with musculoskeletal disorders and/or a history of knee‐related injury/surgery were excluded. Participants were followed for up to 5 years for incident outcomes including 1) radiographic knee OA (RKOA) and 2) joint pain (feet, knees, hips, and back). Footwear data, including ever worn heels of 2 inches or more and daytime/evening hours (per week) spent wearing heeled shoes over five decades (ages <20 years, 20‐30 years, 30‐40 years, and >50 years), were available at Year 10 whereas knee radiographs and joint symptom data were also collected at Year 15. Cumulative time spent wearing heeled shoes was calculated for women reporting ever‐use of heeled shoes (≥2 inches). Multiple logistic regression was used to examine the relationship between exposures and outcomes (from Year 10 to Year 15). Results: A total of 356 women were eligible at Year 10 with a median (interquartile range) age of 60 (56‐65) years. Compared with non‐use, ever‐use of heeled shoes (≥2 inches) was not associated with incident RKOA (1.35; 95% confidence interval: 0.56‐3.27). No associations were observed between increasing cumulative time spent wearing heels and incident outcomes. Conclusion: Compared with the non‐use of heeled shoes, ever‐use of heels (≥2 inches) was not associated with incident RKOA and incident joint symptoms. Further, increasing cumulative time spent wearing heels was not associated with any of our outcomes. [ABSTRACT FROM AUTHOR]

Background: Real time clinical gait analysis (RTCGA) is often incorporated as part of a general or lower limb musculoskeletal (MSK) adult patient assessment. However, it is not known if RTCGA is clinically effective as a useful outcome measure or aids in decision making. Whether there is a clinical worth in conducting RTCGA in adult MSK consultations remains controversial. The aim of this study was to provide unique insights into MSK podiatrists use and opinions of RTCGA, using Posterior Tibial Tendon Dysfunction (PTTD) as an exemplar adult condition. Methods: A qualitative approach was employed to explore MSK podiatrists' views and experiences of RTCGA when assessing or treating patients with PTTD. Semi-structured interviews were conducted via Skype video calls which were transcribed using an orthographic transcription method. Thematic analysis was employed to identify key meanings and report patterns within the data. Results: Twenty nine MSK podiatrists who used RTCGA in the assessment and treatment of PTTD participated in the study. Five themes were identified as 1) RTCGA Method; 2) Working with RTCGA; 3) RTCGA uses; 4) What could aid RTCGA; 5) How RTCGA skills are acquired. This is the first known study to explore this topic of relevance to clinicians and researchers alike. Clinical observations were not only kinematic, but also included patient perceived experiences such as pain and orthotic comfort with normative kinematic reference values not perceived as important to that management goal. The most common barefoot RTCGA observations performed were the rearfoot to leg angle, medial bulge, forefoot abduction and arch integrity. However, a high amount of variation in many gait observations was noted between participants. Documentation methods also varied with a four-point scale system to grade motion and position most often employed and RTCGA was most often learnt through experience. The main barriers to performing RTCGA were clinical time and space restrictions. Conclusion: Findings from this study have provided a view of how podiatry MSK clinicians utilise RTCGA within their practice. MSK podiatrists use RTCGA as both an outcome measure and as an aid in decision making. This implies a perceived worth in conducting RTCGA, however further work is recommended that focusses on development of a national guideline to RTCGA to be adopted. [ABSTRACT FROM AUTHOR]

Background: Podiatrists, in musculoskeletal services, are demonstrating an expansion of their practice skills through the use of ultrasound imaging. There is an assumption that this practice is beneficial within the context of patient care and health systems. The aim of this research was to further investigate the use of musculoskeletal ultrasound (MSUS) by podiatrists within their clinical setting and gain additional insights into the impact that they perceive use of MSUS has on their approaches to management of musculoskeletal foot and ankle problems. Method: An international study utilising a cross-sectional design and an internet-based platform was undertaken. The survey was developed and implemented through three phases: 1. survey development, 2. face validity agreement via questionnaire review, and 3. survey distribution and data collection. Twenty-two survey questions were developed and set as a two-step approach collecting quantitative data (part 1) and qualitative free text data (part 2). Data was exported from SurveyMonkey and analysed using Microsoft Excel software. Counts and frequencies were calculated for responses to all twenty closed questions. Responses to the two final open-ended questions were analysed using thematic analysis to search for patterns related to podiatrists' perceptions of impact. Results: Two hundred and thirty-two eligible participants consented to complete the survey. The majority (n = 159) of respondents were from the UK and Spain. Commonly MSUS has been used in practice for (i) diagnosing pathology, (ii) supporting rehabilitation, (iii) supporting interventions or (iv) research purposes. Most frequently, MSUS was used to assist in the diagnosis of injury/pathology (84%). A range of free text comments were received from the participants in response to the question relating to their thoughts on the impact of using MSUS imaging in their practice (n = 109) and on their perceptions of how the use of MSUS has influenced their approaches to management of their patients' musculoskeletal foot and ankle problems (n = 108). Thematic analysis of the free text comments generated four themes: (i) diagnosis, (ii) delivery and access of care, (iii) patient education and engagement, and (iv) patient empowerment. Conclusion: The perceived benefit podiatrists indicated in using MSUS as part of their practice is the perceived improvement in patient journeys through tighter, focused management plans and reduced waiting times. An additional novel finding was that MSUS provided the capacity for podiatrists to better inform patients of their diagnosis, which they believed led to improved engagement and consequent empowerment of patients in their treatment plans. We propose further investigation of patient experiences as well as testing of the model that embeds podiatrists' use of MSUS as a key skill in musculoskeletal foot and ankle services. [ABSTRACT FROM AUTHOR]

We use questionnaire data from the MIDUS study (N = 6325 and a subsample n = 2120) to examine the extent to which people in their late 20s, late 40s and late 60s think that positive characteristics apply to themselves, their age peers and other age groups. Results based on factor analysis confirmed the existence of age stereotypes, such that one constellation of characteristics (wise, caring, calm, knowledgeable, generative; "wise") was seen as more descriptive of older adults, while another constellation of characteristics (energetic, healthy, willing to learn; "energetic") was seen as more descriptive of younger adults. Self-evaluations were, however, highly positive and largely independent of age. As a group, younger adults saw themselves as being as "energetic" but "wiser" than their age peers, while older adults saw themselves as being more "energetic" but less "wise" than their age peers. In sum, the results suggest that self-views are relatively independent of existing age stereotypes but also indicate that the "better-than-average effect" depends on age and whether the considered characteristics represent a relative strength or weakness of one's own age group. The results also indicate that, at the aggregate level, older adults' tendency to use stereotypes about their age group's weaknesses as a frame of reference for making flattering self-evaluations seems to outweigh the effects of stereotype internalization. [ABSTRACT FROM AUTHOR]

Views on ageing (VoA) have special relevance for the ageing process by influencing health, well-being, and longevity. Although VoA form early in life, so far, most research has concentrated on how VoA affect later middle-aged and older adults. In this theoretical article, we argue that a lifespan approach is needed in order to more fully understand the origins of VoA, how they change over ontogenetic time, and how they shape development across the full breadth of the lifespan. We begin by explicitly linking VoA to fundamental principles of lifespan development. We review existing theories of VoA and discuss their respective contributions and limitations. We then outline a lifespan approach to VoA that integrates existing theories and addresses some of their limitations. We elaborate on three core propositions of a lifespan approach to VoA: (1) VoA develop as the result of a dynamic, ongoing, and complex interaction between biological-evolutionary, psychological, and social-contextual factors; however, the relative importance of different sources changes across the lifespan; (2) VoA impact development across the whole lifespan; however, different outcomes, mechanisms, and time frames need to be considered in order to describe and understand their effects; and (3) VoA are multidimensional, multidirectional, and multifunctional throughout life, but their complexity, meaning, and adaptivity change across the lifespan. We conclude with recommendations for future lifespan research on VoA. [ABSTRACT FROM AUTHOR]

Although a large body of research has demonstrated the predictive power of subjective ageing for several decisive developmental outcomes, there remains some controversy about whether subjective ageing truly represents a unique construct. Thus, information about the convergent and discriminant validity of different approaches to measuring subjective ageing is still critically needed. Using data from the 2014 wave of the German Ageing Survey, we examined how three established subjective ageing measures (subjective age, global attitude toward own ageing, multidimensional ageing-related cognitions) were inter-related as well as distinct from general dispositions (optimism, self-efficacy) and well-being (negative affect, depressive symptoms, self-rated health). Using correlational and multivariate regression analysis, we found that the three subjective ageing measures were significantly inter-related (r = |.09| to |.30|), and that each measure was distinct from general dispositions and well-being. The overlap with dispositional and well-being measures was lowest for subjective age and highest for global attitudes towards own ageing. The correlation between global attitudes towards own ageing and optimism was particularly striking. Despite the high convergent validity of the different dimensions of ageing cognitions, we nevertheless observed stronger associations between specific dimensions of ageing cognitions with negative affect and self-rated health. We conclude that researchers should be aware of the multidimensional nature of subjective ageing. Furthermore, subjective age appears to be a highly aggregated construct and future work is needed to clarify its correlates and reference points. [ABSTRACT FROM AUTHOR]

Objective: To assess the long-term prevalence, natural history, progression, and incidence of radiographic first metatarsophalangeal (MTP) joint osteoarthritis (OA).Methods: A longitudinal cohort design was used in which radiographic OA at the first MTP joint was investigated in participants from the Chingford 1,000 Women Study at year 6 (1995) and year 23 (2013-2015). Radiographic features of osteophytes (OPs) and/or joint space narrowing (JSN) at the first MTP joint were scored according to a validated foot atlas. Natural history was determined by the change in prevalence, incidence, progression, and worsening of OA in the first MTP joint.Results: Complete case-matched foot radiographic data were available for 193 of the women currently enrolled in the study (mean ± SD age 75.7 ± 5.2 years [range 69-90 years]). At the level of the first MTP joint, prevalence of OA at year 6 was 21.76% in the left and 24.35% in the right; at year 23, it was 23.83% in the left and 32.64% in the right. Over the 19-year period, 13.5% of the women developed incident OA in the right first MTP joint and 8.3% in the left. Both progression and worsening of OA were more evident for OPs and in the right first MTP joints.Conclusion: In this study of the natural history of radiographic first MTP joint OA, which to our knowledge is the longest study to date, the prevalence and incidence of first MTP joint OA increased over a 19-year period. Progression and/or worsening of OA at the first MTP joint over time appears to be driven by OP development rather than JSN, which suggests a biomechanical cause. [ABSTRACT FROM AUTHOR]

Young adults in more developed countries can expect to celebrate their 85th, 90th and even their 100th birthdays. Although time horizons have a major influence on behavior and adult development, little is currently known about how young people feel about the prospect of living such long lives. We therefore explored young adults' preferred life expectancy (how long one wants to live) based on questionnaire data from N = 715 university students in Austria, Norway, Poland and Russia. The countries represented in the sample differ substantially with regard to period life expectancy and the extent to which women outlive men. Overall, participants indicated wanting to live for M = 87.43 years (SD = 14.91), M = 8.12 years longer than they expect to live and M = 13.04 years longer than they think that an average person with the same age and sex will live. There was thus no indication that participants felt that they will live "too long." There was a 7-year difference between the country subsamples with the highest and lowest PLE, providing first evidence that PLE meaningfully differs across countries. Men wanted to live longer than women in each country subsample. Despite country differences in the extent to which women outlive men, there was no evidence that the magnitude of the gender difference in PLE differed across country subsamples. PLE was also related to young people's representations of old age and subjective health. Young people who prefer to die relatively young (< 80 years) were much more likely to use tobacco daily and be physically inactive than their peers. [ABSTRACT FROM AUTHOR]

Background: Evidence based practice enhances service planning and delivery, clinical decision making and patient care. However, health professionals often lack the time and opportunity to access or generate evidence. Research capacity building is thus an important mechanism for improving health service delivery. This study evaluates the effectiveness of a UK-wide Nurse and Allied Health Professional musculoskeletal research internship programme in which graduates applied to undertake their internship through one of five Higher Education Institutions. The evaluation explores the experiences of interns and their mentors.Methods: Sixteen new graduates completed the internship programme (September 2015 - August 2018). Twelve interns and thirteen mentors participated in the evaluation. The evaluation used qualitative asynchronous email-based interviews to explore the experiences of interns and mentors. Interpretive phenomenological analysis of coded transcripts identified principal themes.Results: Early research outputs from the interns include three peer reviewed publications and 21 conference abstract presentations. Two interns were in full time research at the time of interview or had a research component in their clinical role. Nine interns in clinical posts disclosed plans to return to research in the near future. Seven themes were identified: the impact on interns' careers; personal impact (for example, influence on self-confidence); impact on clinical practice; drivers for applying; intervention design (for example, attitudes concerning the timing and duration of the intervention); mentorship and networking (including general support provided and quality of career advice); challenges.Conclusion: The internship programme is an effective model in building research capacity in musculoskeletal research for Nurses and Allied Health Professionals, influencing careers, building confidence and improving clinical practice. The internship programme has the potential to be replicable to other clinical contexts nationally and internationally. [ABSTRACT FROM AUTHOR]

Purpose: Foot problems and suboptimal footwear are risk factors for falls among the elderly. Footwear choice may, therefore, be important for people with balance impairment following stroke, but little is known about their experience. This study explored foot problems experienced following stroke, factors influencing footwear choices and views of footwear in use. Methods: Semi-structured interviews with 15 people with stroke, purposively sampled from respondents to a screening survey. Results: Participants typically experienced impaired mobility with balance problems and felt at risk of falling. Stroke related foot problems, including altered sensation, edema, and foot drop, predominantly on the stroke affected side, influenced footwear priorities. Footwear choices prioritized comfort, security, and convenience, sometimes in tension with concern about appearance. Challenges included choosing appropriate indoor footwear and finding shoes to accommodate their orthoses and edema. Participants highlighted perceived lack of footwear advice from health care professionals and variable experience of shoe shopping. Conclusions: Foot problems, as well as gait and balance impairment, have implications for footwear priorities following stroke, but people felt unsupported in making healthy footwear choices. Health care professionals could be trained to routinely deliver footwear assessment and advice and facilitate referrals to podiatrist, when appropriate. Foot problems, as well as gait and balance impairment, have implications for footwear priorities following stroke. People with stroke perceive a lack of professional advice about footwear and feel unsupported making healthy footwear choices. Health care professionals could be trained to routinely deliver an initial footwear assessment and advice as part of stroke rehabilitation. A greater transparency and knowledge of referral pathways into podiatry services for Health care professionals and patients would give access to specialist advice where appropriate. [ABSTRACT FROM AUTHOR]

Well-being in retirement is thought to depend on person's level of resources and how his or her resources change during retirement. However, to date few studies have directly investigated resource trajectories during retirement. The current study therefore examines how economic, personal, and social-relational resources change during the retirement transition for people retiring from paid employment and for people retiring from other, non-working labour market statuses (e.g. disability pension, homemaker, unemployment). Based on four representative baseline samples of the German Ageing Survey (1996, 2002, 2008, and 2014) and their respective 6-year follow-up interviews, we identified N = 586 retirees. We then used dual change score models to separately estimate the level and change in income, health, activity, family and non-family network size, and social support for people retiring from paid work (n = 384) and people retiring from other statuses (n = 202) adjusted for age, gender, education, region, period, and time since retirement. Overall, we found that resources changed only modestly during the retirement transition. Resource changes did, however, differ by last labour market status and sociodemographic characteristics. Income and social support declined and family networks increased for both those retiring from paid work and those retiring from other statuses. Leisure activities increased only for those retiring from paid work. No changes in health or non-family networks were observed. People with many resources before retirement also had many resources after retirement. We conclude that retirement affects resources less than researchers often expect. Accordingly, differences based on labour market remain despite retirement. [ABSTRACT FROM AUTHOR]

Background: Older patients who have foot pain report variation in access to services to manage their foot health. To plan services it is essential to understand the scale and burden of foot pain that exists for GPs.Aim: To provide UK-wide population-level data of the frequency of foot and/or ankle pain encounters recorded in general practice.Design and Setting: Population-based cohort design study using data drawn from the UK Clinical Practice Research Datalink (CPRD) from January 2010 to December 2013.Method: All CPRD data were collected prospectively by participating GPs. The primary outcome was prevalence of GP encounters for foot and/or ankle pain, stratified by age, sex, and different subgroups of causes.Results: A foot and/or ankle pain encounter was recorded for 346 067 patients, and there was a total of 567 095 recorded encounters (mean per person 1.6, standard deviation [SD] 1.3). The prevalence of recorded encounters of foot and/or ankle pain was 2980 per 100 000 (3%). The number of patients with a recorded encounter of foot and/or ankle pain was 1820 per 100 000 (1.8%). Foot and/or ankle pain encounters were reported across all age groups (54.4% females), with those aged 71-80 years placing the greatest burden on GPs. The most common specified referrals were to orthopaedics (n = 36 881) and physiotherapy (n = 33 987), followed by podiatry (n = 25 980).Conclusion: The burden of foot and/or ankle pain encounters recorded by GPs is not insubstantial, and spans all ages, with a high proportion of referrals to orthopaedics. The authors recommend further exploration of 'first-contact practitioners' for foot and/or ankle pain in general practice to alleviate the burden on GPs. [ABSTRACT FROM AUTHOR]

Objective: Despite the potential burden of foot pain, some of the most fundamental epidemiologic questions surrounding the foot remain poorly explored. The prevalence of foot pain has proven to be difficult to compare across existing studies due to variations in case definitions. The objective of this study was to investigate the prevalence of foot pain in several international population-based cohorts using original data and to explore differences in the case definitions used.Methods: Foot pain variables were examined in 5 cohorts: the Chingford 1000 Women Study, the Johnston County Osteoarthritis Project, the Framingham Foot Study, the Clinical Assessment Study of the Foot, and the North West Adelaide Health Study. One question about foot pain was chosen from each cohort based on its similarity to the American College of Rheumatology pain question.Results: The precise definition of foot pain varied between the cohorts. The prevalence of foot pain ranged from 13% to 36% and was lowest in the cohort in which the case definition specific to pain was used, compared to the 4 remaining cohorts in which a definition included components of pain, aching, or stiffness. Foot pain was generally more prevalent in women and obese individuals and generally increased with age, with the prevalence being much lower in younger participants (ages 20-44 years).Conclusion: Foot pain is common and is associated with female sex, older age, and obesity. Estimates of the prevalence of foot pain are likely to be affected by the case definition used. Therefore, in future population studies, the use of consistent measures of data collection must be considered. [ABSTRACT FROM AUTHOR]

"Dementia worry" (DW; i.e., concern about developing dementia) is highly prevalent in the general population. However, research on the characteristics associated with lower and higher levels of DW is still limited. Based on previous empirical and conceptual work, we examined the extent to which DW was related to a comprehensive range of objective and subjective characteristics (sociodemographics, contact with people with dementia, physical health-related risk factors, well-being/psychological distress, aging self-perceptions, social-cognitive health beliefs about dementia). A convenience sample of N = 219 German adults 40 + years (M = 65.50 years, SD = 11.34; 40-94 years) reporting no dementia or cognitive impairment diagnosis completed questionnaires. We improved upon previous research by using a ten-item scale to measure DW. We used bivariate correlations and multivariate regression to examine the extent to which DW was related to the potential concomitants. 41.1% of the participants indicated DW. Together, the predictor variables explained 53.3% of the variance in DW. DW was related to psychological distress, perceived memory change, aging anxiety, and personal risk perception in both the bivariate and multivariate analyses. There was a quadratic (reverse U shape) relationship between age and DW. Physical health-related risk factors were not related to DW. Our findings suggest that DW represents a hybrid of psychological distress, aging self-perceptions, and a specific type of health concern. Healthcare practitioners should consider a person's psychological characteristics when deciding how to intervene when someone indicates moderate or high DW. [ABSTRACT FROM AUTHOR]

Background: Ankle sprain is a very common injury, yet uncertainty exists in what is appropriate time to return to play (RTP). Such guidance may inform treatment pathways and effective practice. Objectives: To determine if consensus exist about potential influencing factors for time to RTP in conservatively treated ankle sprain. Methods: We searched AMED, CINAHL Plus, Cochrane library, EMBASE, MEDLINE (EBSCO), SPOERDiscus, PsycINFO, PEDro, Scopus, unpublished literature and ongoing trials and Google Scholar from inception until April 2017. The quality of the eligible papers was assessed using the Downs and Black tool for randomized controlled trials (RCTs) and Critical Appraisal Skills Program (CASP) for observational studies. Results: The initial search identified 1885 articles. After screening, 14 articles were included. Of these, 11 were RCTs and 3 were prospective observational studies. Individual treatment methods that resulted in a shorter time to RTP were functional treatment, compression stockings, anteroposterior joint mobilization, hyaluronic acid injection (HA), Jump Stretch Flex Band programme (JSFB) and diclofenac medication. Prognostic factors for determining time to RTP in the included prospective observational studies were measures of Global function, SF 36PF, athlete's ambulation status, weight-bearing activity scores and self-reported athletic ability. Conclusion: To our knowledge, this is the first review to report influencing factors for time to RTP following conservatively treated ankle sprain. Findings from this review identified factors that influence time to RTP. However, caution should be taken in generalizing these results due to the heterogeneity of studies and inability to clearly define and list the criteria for safe RTP. The inclusion of factors such as age, sex, BMI, level of sport, injury related factors in future studies might help to understand the course of injury and therefore assist in constructing safer criteria. [ABSTRACT FROM AUTHOR]

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Objectives Previous studies have found that individuals' health is associated with the social characteristics of their communities. However, interpreting the causality of the relationships is difficult due to a number of potential confounders on both the individual- and community-levels as well as potential selection effects. In the current article, we analyze data on health and community characteristics from Catholic order members aged 50+ living together in religious communities. We argue that the potential for confounders and selection effects is reduced in our sample. Method We use multilevel group actor–partner interdependence models and cross-sectional questionnaire data (N = 1,041, k = 156 communities) to test whether individuals' self-rated health was associated with the level of social conflict and connectedness of their community separate from their own involvement in conflict and feelings of connectedness. Results We find that living in communities with higher levels of conflict is associated with worse health, especially at older ages. We also find that (a) the relationship between health and own feelings of connectedness is stronger for men and (b) women report better health than men in more connected communities. Discussion Our results offer further evidence that at least some social characteristics of the community have a causal impact on health. [ABSTRACT FROM AUTHOR]

Objectives: To identify by systematic review published prevalence estimates of radiographic ankle osteoarthritis (OA) and to subsequently estimate the prevalence of ankle pain and symptomatic, radiographic ankle OA within community-dwelling older adults from North Staffordshire, UK. Methods: Electronic databases were searched using terms for ankle, osteoarthritis and radiography. Data regarding population, radiographic methods, definitions and prevalence estimates of ankle OA were extracted from papers meeting predetermined selection criteria. Adults aged ≥50 years and registered with four general practices in North Staffordshire were mailed a health questionnaire. Ankle pain in the previous month was determined using a foot and ankle pain manikin. Respondents reporting pain in or around the foot in the last 12 months were invited to attend a research clinic where weight-bearing, antero-posterior and lateral ankle radiographs were obtained and scored for OA using a standardised atlas. Prevalence estimates for ankle pain and symptomatic, radiographic ankle OA were calculated using multiple imputation and weighted logistic regression, and stratified by age, gender and socioeconomic status. Results: Eighteen studies were included in the systematic review. The methods of radiographic classification of ankle OA were poorly reported and showed heterogeneity. No true general population prevalence estimates of radiographic ankle OA were found, estimates in select sporting and medical community-dwelling populations ranged from 0.0–97.1%. 5109 participants responded to the health survey questionnaire (adjusted response 56%). Radiographs were obtained in 557 participants. The prevalence of ankle pain was 11.7% (10.8,12.6) and symptomatic, radiographic ankle OA grade≥2 was 3.4% (2.3, 4.5) (grade≥1: 8.8% (7.9,9.8); grade = 3: 1.9% (1.0,2.7). Prevalence was higher in females, younger adults (50–64 years) and those with routine/manual occupations. Conclusion: No general population prevalence estimates of radiographic ankle OA were identified in the published literature. Our prevalence study found that ankle pain was common in community-dwelling older adults, whereas moderate to severe symptomatic, radiographic ankle OA occurred less frequently. Further investigations of the prevalence of ankle OA using more sensitive imaging modalities are warranted. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagnosis of forefoot neuroma. Methods: A four-round Delphi consensus study was completed with 16 expert health professionals from either a clinical or clinical academic background, following completion of a structured literature review. Clinical experience ranged from 5 to 34 years (mean: 19.5 years). Consensus was sought on the optimal methods to achieve the clinical diagnosis of forefoot neuroma. Round 1 sought individual input with an open ended question. This developed a list of recommendations. Round 2 and 3 asked the participants to accept or reject each of the recommendations in the list in relation to the question: "What is the best way to clinically diagnose neuroma in the forefoot?" Votes that were equal to or greater than 60% were accepted into the next round; participant's votes equal to or less then 20% were excluded. The remaining participant's votes between 20 to 60% were accepted and placed into the following round for voting. Round 4 asked the participants to rank the list of recommendations according to the strength of recommendation they would give in relation to the question: "What is the best way to clinically diagnose neuroma in the forefoot?" The recruitment and Delphi rounds were conducted through email. Results: In round 1, the 16 participants identified 68 recommendations for the clinical diagnosis of forefoot neuroma. In round 2, 27 recommendations were accepted, 11 recommendations were rejected and 30 recommendations were assigned to be re-voted on. In round 3, 36 recommendations were accepted, 22 recommendations were rejected and 11 recommendations were assigned to be re-voted on. In round 4, 21 recommendations were selected by the participants to form the expert derived clinical assessment protocol for the clinical diagnosis of forefoot neuroma. From these 21 recommendations, a set of themes were established: location of pain, non weight bearing sensation, weight bearing sensation, observations, tests and imaging. Conclusion: Following the identification of 21 method recommendations, a core set of clinical diagnostic methods have been prepared as a clinical assessment protocol for the diagnosis of forefoot neuroma. Based on expert opinion, the core set will assist clinicians in forming a clearer diagnosis of forefoot neuroma. [ABSTRACT FROM AUTHOR]

Background: The prevalence of foot osteoarthritis (OA) is much less understood than hip, knee and hand OA. The foot is anatomically complex and different researchers have investigated different joints with lack of methodological standardisation across studies. The La Trobe Foot Atlas (LFA) is the first to address these issues in providing quantitative assessment of radiographic foot OA, but has not been tested externally. The aim of this study was to evaluate three different interpretive approaches to using the LFA for grading OA when scoring is difficult due to indistinct views of interosseous space and joint contour. Methods: Foot radiographs of all remaining participants (n = 218) assessed in the Chingford Women Study 23 year visit (mean (SD) for age: 75.5 years (5.1)) were scored using the LFA defined protocol (Technique 1). Two revised scoring strategies were applied to the radiographs in addition to the standard LFA analyses. Technique 2 categorised joints that were difficult to grade as 'missing'. Technique 3 included joints that were difficult to grade as an over estimated score. Radiographic OA prevalence was defined for the foot both collectively and separately for individual joints. Results: When radiographs were scored using the LFA (Technique 1), radiographic foot OA was present in 89.9%. For Technique 2 the presence of radiographic foot OA was 83.5% and for Technique 3 it was 97.2%. At the individual joint level, using Technique 1, the presence of radiographic foot OA was higher with a wider range (18.3-74.3%) than Technique 2 (17.9-46.3%) and lower with a wider range (18.3-74.3%) than Technique 3 (39.9-79.4%). Conclusion: The three different ways of interpreting the LFA scoring system when grading of individual joints is technically difficult and result in very different estimates of foot OA prevalence at both the individual joint and global foot level. Agreement on the best strategy is required to improve comparability between studies. [ABSTRACT FROM AUTHOR]

Background: Research focusing on management of foot health has become more evident over the past decade, especially related to chronic conditions such as diabetes. The level of methodological rigour across this body of work however is varied and outputs do not appear to have been developed or translated into clinical practice. The aim of this systematic review was to assess the latest guidelines, standards of care and current recommendations relative to people with chronic conditions to ascertain the level of supporting evidence concerning the management of foot health. Methods: A systematic search of electronic databases (Medline, Embase, Cinahl, Web of Science, SCOPUS and The Cochrane Library) for literature on recommendations for foot health management for people with chronic conditions was performed between 2000 and 2016 using predefined criteria. Data from the included publications was synthesised via template analysis, employing a thematic organisation and structure. The methodological quality of all included publications was appraised using the Appraisal for Research and Evaluation (AGREE II) instrument. A more in-depth analysis was carried out that specifically considered the levels of evidence that underpinned the strength of their recommendations concerning management of foot health. Results: The data collected revealed 166 publications in which the majority (102) were guidelines, standards of care or recommendations related to the treatment and management of diabetes. We noted a trend towards a systematic year on year increase in guidelines standards of care or recommendations related to the treatment and management of long term conditions other than diabetes over the past decade. The most common recommendation is for preventive care or assessments (e.g. vascular tests), followed by clinical interventions such as foot orthoses, foot ulcer care and foot health education. Methodological quality was spread across the range of AGREE II scores with 62 publications falling into the category of high quality (scores 6-7). The number of publications providing a recommendation in the context of a narrative but without an indication of the strength or quality of the underlying evidence was high (79 out of 166). Conclusions: It is clear that evidence needs to be accelerated and in place to support the future of the Podiatry workforce. Whilst high level evidence for podiatry is currently low in quantity, the methodological quality is growing. Where levels of evidence have been given in in high quality guidelines, standards of care or recommendations, they also tend to be strong-moderate quality such that further strategically prioritised research, if performed, is likely to have an important impact in the field. [ABSTRACT FROM AUTHOR]

How long do people want to live? Why do some people want to live a very long time, and others would rather die relatively young? In the current study we examine the extent to which the preference to die young (<80 years, less than average life expectancy) or to live somewhat longer or much longer than average life expectancy (90-99 years or 100+ years, respectively) is related to a person's positive and negative expectations of what their life will be like in old age. We use multinomial regression analysis based on survey data from a large sample of younger and middle-aged adults in the United States of America (USA) (N = 1,631, age 18-64 years). We statistically control for socio-demographic characteristics as well as self-reported happiness and health. We find that having fewer positive expectations for their own old age distinguishes people who prefer to die relatively young, while having fewer negative expectations distinguishes people who want to live beyond current levels of life expectancy. The results provide evidence that pessimistic expectations of life in old age can undermine the desire to live up to and beyond current average life expectancy. The study also provides descriptive data about how young and middle-aged adults in the USA anticipate their own ageing. [ABSTRACT FROM AUTHOR]

Background: Despite significant advancements in new treatment modalities for rheumatoid arthritis with biological therapies, foot complications remain a disabling and common feature of the disease. In this study the aim was to explore and describe the personal experiences of people with rheumatoid arthritis in receipt of biologic treatments in a bid to understand the impact of this form of medication on their mobility. Methods: An interpretative phenomenological analysis (IPA) was undertaken to explore in depth the individual experience of rheumatoid disease through personal accounts of the patient journey spanning both 'before' and 'after' the instigation of biologic therapy. A purposive sampling strategy was adopted and in-depth semi structured interviews used to facilitate rich, detailed interview data exploring the lived experiences of individuals undertaking biological therapy and the changes to mobility experienced as a result. Thematic analysis was employed with an IPA framework to identify key meanings, and report patterns within the data. Results: Five people with rheumatoid arthritis participated in the study. The mean disease duration was 20.2 years (range: 6 -32) and all were being treated with biologic therapies. Four key themes emerged from the data: 1) Life before biologic treatment, depicted in accounts as a negative experience characterised by painful and disabling symptoms and feelings of hopelessness. 2) Life with biologic treatment, often experienced as a life changing transition, restoring function and mobility and offering renewed hope. 3) Sense of self, in which the impact of rheumatoid disease and the subsequent changes arising from biologic therapy reveal a profound impact on feelings of personal identity both pre and post biologic therapy; an effect of footwear on self-image emerges as a dominant sub theme; 4) Unmet footcare needs were evident in the patient narrative, where the unrelenting if diminished impact of foot pain on mobility was viewed in the context of problematic access to foot health services. Conclusion: Whilst the findings from this study mirror those within the existing literature, which report improvements in physical function related to biological therapy, foot problems clearly remained an unremitting feature of life for patients with rheumatoid disease, even when in receipt of biologics. [ABSTRACT FROM AUTHOR]

Background: Ill-fitting shoes have been implicated as a risk factor for falls but research to date has focused on people with arthritis, diabetes and the general older population; little is known about people with neurological conditions. This survey for people with stroke and Parkinson's explored people's choice of indoor and outdoor footwear, foot problems and fall history. Methods: Following ethical approval, 1000 anonymous postal questionnaires were distributed to health professionals, leads of Parkinson's UK groups and stroke clubs in the wider Southampton area, UK. These collaborators handed out survey packs to people with a confirmed diagnosis of stroke or Parkinson's. Results: Three hundred and sixty three completed surveys were returned (218 from people with Parkinson's and 145 from people with stroke). Most respondents wore slippers indoors and walking shoes outdoors and considered comfort and fit the most important factors when buying footwear. Foot problems were reported by 43 % (95 % confidence intervals 36 to 52 %; stroke) and 53 % (95 % confidence interval 46 to 59 %; Parkinson's) of respondents; over 50 % had never accessed foot care support. Fifty percent of all respondents reported falls. In comparison to non-fallers, a greater proportion of fallers reported foot problems (57 %), with greater proportions reporting problems impacting on balance and influencing choice of footwear (p < 0.01) in comparison to non-fallers in each case. Forty-seven percent of fallers with foot problems had not accessed foot care support. Conclusions: Many people with stroke and Parkinson's wear slippers indoors. A high percentage of these individuals reported both foot problems and falls impacting on footwear habits and choice of footwear; however many did not receive foot care support. These findings highlight that further exploration of footwear and foot problems in these populations is warranted to provide evidence based advice on safe and appropriate footwear to support rehabilitation and fall prevention. [ABSTRACT FROM AUTHOR]

Background: The main aim of this study was to determine the prevalence of US-detectable forefoot bursae, metatarsophalangeal (MTP) joint and metacarpophalangeal (MCP) joint synovial hypertrophy (SH), Power Doppler (PD) signal or erosion in participants with systemic lupus erythematosus (SLE). A secondary aim was to determine the strength of potential association between patient reported foot-related disability and US-detected forefoot bursae, MTP joint SH, PD signal or erosion in participants with SLE. Method: A cross-sectional observational study of 20 participants with SLE was completed to determine the prevalence of US-detected forefoot bursal, MTP and MCP joint pathology. Patient-reported foot-related impairment and activity limitation (accumulatively referred to as disability) were also recorded. Spearmans' Rank Correlation analyses were completed to determine the potential strength of association between US-detected pathology and patient report disability. Results: The prevalence of MTP joint SH and PD was 80 % (16/20) and 10 % (2/20), respectively. The prevalence of MCP joint SH and PD was 60 % (12/20) and 30 % (6/20) respectively. A significant association was noted between PD scores for the MTP joints and MCP joints (r = 0.556; p = 0.011) although this was not demonstrated for SH scores (r = 0. 176; p = 0.459). Significant associations between forefoot bursal prevalence and MTP joint PD were noted (r = 0. 467; p = 0.038). The prevalence of bursae and bursal PD (grade 2 or above) was 100 % (20/20) and 10 % (2/20), respectively. Moderate foot-related impairment and activity limitation was reported by 95 and 85 % of participants respectively. Conclusion: This pilot study suggests that US-detected MTP, MCP joint and forefoot bursal abnormalities may be prevalent in participants with SLE and they may experience a moderate level of foot-related disability. Further research is required to substantiate these preliminary findings. [ABSTRACT FROM AUTHOR]

The article offers the authors' views on the continued application of subtalar joint neutral theory (STJN) in treating foot-associated musculoskeletal symptomology. They mention that the theory was made by physician Merton L. Root who conducted biomechanical evaluations which led him to acknowledge the significance of the joint. An overview of its unreliability and inaccuracy to its history is also presented.s

Objectives:Especially older adults underutilize professional mental health services. However, little is known about the factors associated with older adults’ attitudes towards seeking mental health services (ATSMHS). We therefore investigated a wide range of contextual (e.g. physical access, residence) and personal (e.g. perceived social support, life satisfaction, openness to experience) predictors of ATSMHS in a sample of older community-dwelling adults in Germany. We predicted that representations of old age as well as perceptions of (younger) psychotherapists would be uniquely important for determining ATSMHS. Method:A diverse sample ofN= 156 older adults (Mage= 71.5 years, SD = 6.4, range: 60–92) completed questionnaire measures. We used hierarchical linear regression analyses to identify predictors of ATSMHS. Results:In the final saturated model, female gender, urban residence, personal and vicarious experience with psychotherapy, and higher perceived social support were each associated with more positive ATSMHS. In addition, more positive representations of old age and less negative perceptions of (younger) psychotherapists explained unique variance in ATSMHS over and above the other predictors. The overall model was significant and explained 49% of the variance in ATSMHS. Conclusion:Our findings can be used to inform interventions to improve older adults’ ATSMHS. Interventions that seek to improve older adults’ representations of their own aging as well as of psychotherapists may be useful for reducing the treatment gap. [ABSTRACT FROM PUBLISHER]

Objective. The aim of this study was to determine the reliability of an MRI-based score that evaluates forefoot bursae (FFBs) in patients with RA.Methods. Items for inclusion, grading criteria and MRI sequences were determined iteratively. The score was evaluated in 30 patients with established RA. Reader agreement was evaluated using the percentage of exact/close agreement, Bland–Altman plots, kappa and intraclass correlation coefficient analyses.Results. The FFB score assesses nine forefoot regions and contains four items: presence, shape, enhancement and magnetic resonance characteristics. The FFB score showed moderate to good intra- and interreader agreement (κ range = 0.5–0.9 and 0.47–0.87, respectively).Conclusion. The FFB score is adequately reliable in the evaluation of bursa-like lesions of the forefoot in patients with RA. [ABSTRACT FROM PUBLISHER]

Background: In the last decade there has been a significant expansion in the body of knowledge on the effects of rheumatoid arthritis (RA) on the foot and the management of these problems. Aligned with this has been the development of specialist clinical roles for podiatrists. However, despite being recommended by national guidelines, specialist podiatrists are scarce. In order to inform non-specialist podiatrists of the appropriate interventions for these foot problems, management guidelines have been developed and disseminated by a group of specialist podiatrists. The aim of this survey was to investigate the use of these guidelines in clinical practice. Method: Following ethical approval an online questionnaire survey was carried out. The questions were formulated from a focus group and comprised fixed response and open response questions. The survey underwent cognitive testing with two podiatrists before being finalised. An inductive approach using thematic analysis was used with the qualitative data. Results: 245 questionnaires were completed (128-non-specialist working in the private sector, 101 non-specialists working in the NHS and 16 specialist podiatrists). Overall, 97% of the non-specialists (n = 222) had not heard of the guidelines. The non-specialists identified other influences on their management of people with RA, such as their undergraduate training and professional body branch meetings. Three main themes emerged from the qualitative data: (i) the benefits of the foot health management guidelines, (ii) the barriers to the use of guidelines generally and (iii) the features of useable clinical guidelines. Conclusions: This study has revealed some crucial information about podiatrists' level of engagement with the foot health management guidelines and the use of guidelines in general. Specifically, the non-specialist podiatrists were less likely to use the foot health management guidelines than the specialist podiatrists. The positive aspects were that for the specialist practitioners, the guidelines helped them to identify their professional development needs and for the few non-specialists that did use them, they enabled appropriate referral to the rheumatology team for foot health management. The barriers to their use included a lack of understanding of the risk associated with managing people with RA and that guidelines can be too long and detailed for use in clinical practice. Suggestions are made for improving the implementation of foot health guidelines. [ABSTRACT FROM AUTHOR]