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Various clamp designs have been proposed over the years with different degrees of complexity and actual performance vis-à-vis correct grip and reduced impact on the surface strains of the tendon sample. The previous studies all focused on impact on ultimate tensile strain and Young's modulus of the tendons. Here an innovative clamp design is proposed that utilizes the fairly recently available technology that is 3D printing to produce a made-to-measure tendon sleeve that encloses the sample ends and also enables straightforward alignment within the testing equipment. All experiments are carried out using the superficial digital flexor tendons obtained from pig hind legs. The Young's moduli for the linear region of the tendon obtained using this clamp design are very similar to those obtained using the cryo Jaw by other researchers for the same tendon. Furthermore, negative Poisson's ratios are also obtained for the toe-region, in agreement with previous work. [ABSTRACT FROM AUTHOR]

Introduction: Chronic plantar heel pain (CPHP) is a significant, painful condition referring to a range of undifferentiated foot conditions that affect the heel of the foot.Method: Participants presenting with CPHP of more than 6 months' duration were recruited on a first through the door basis. Computer-Aided Design and Computer-Aided Manufactured (CAD-CAM) orthoses were designed and constructed for each participant, then dispensed as per normal practice. Pre- and postintervention assessment of pain was performed at baseline and after 6 weeks of use, utilizing the pain subset of the Foot Function Index (FFI).Results: There was a significant reduction in the mean pain scores for all participants in all constructs of the FFI. Total FFI score was also significant ( P = .003).Conclusion: CAD-CAM orthoses have the potential to become a treatment modality of choice in CPHP since they have resulted in a significant improvement in heel pain after only 6 weeks' use.Levels Of Evidence: Therapeutic, Level IV: Prospective, comparative trial. [ABSTRACT FROM AUTHOR]

Aim: To determine whether thermography could detect diabetes foot complications of peripheral arterial disease (PAD), neuropathy and neuroischaemia when compared with those of healthy adults. Method: Participants were categorized into five groups: healthy, healthy diabetes, PAD and neuroischaemic groups following a clinical examination. Thermography of the foot was then performed at an ambient temperature of 23oC. Results / Discussion: 43 neuroischaemic feet, 41 neuropathic feet, 58 PAD feet, 21 DM feet without complications, and 126 healthy feet were had thermographic imaging which were then analyzed. The temperatures of the feet and toes were significantly higher in the complications group when compared to the healthy adult and DM healthy groups. Results of this study show that the higher the temperatures of the foot in DM, the higher the probability that it is affected by neuropathy, neuroischaemia, or PAD (figure 1). Conclusion: There were significant differences between the temperatures of healthy feet and the feet of participants with complications. This suggests that thermography can possibly be utilized as a quick non-contact screening tool to detect patients with these complications, whereby such patients can be quickly identified by this emerging technology. This would save both clinical and human resources by avoiding having to screen all diabetes patients, thus enabling clinicians to spend more time with those patients with complications. [ABSTRACT FROM AUTHOR]

Aim: To identify any difference in mental health status and quality of life in lower limb amputees with diabetes compared to individuals without lower limb amputation. Method: A prospective, matched, non-experimental study was conducted at a diabetic foot ward. Subjects were divided into two groups. Group 1: 38 participants undergone a minor amputation and group 2: 38 participants without amputation /history of amputation. Participants were interviewed twice using two questionnaires to screen for mental health status and quality of life. These included the SRQ 20 and EQ-5D-5L. Interviews occurred one week post amputation and after 6 months. Results / Discussion: The mean SRQ 20 score for group 1 at time 0 [1 week post amputation] was that of 8.50, whilst for group 2 was that of 1.34. Since a threshold level of 8 or more suggests psychological distress, the results are indicative that group 1 showed positive presence of mental health disorder. At Time 1 the mean SRQ 20 for group 1 decreased to 5.42 indicating a decrease in psychological distress after six months. Significant differences in the mean values for each dimension of the EQ 5D 5L between group 1 and group 2 indicated that amputees had poorer quality of life than individuals without amputation at time 0 and time 1. Conclusion: Mental health and quality of life are negatively affected after minor lower limb amputation. Routine screening for depression is recommended. Mental health matters MUST NOT be relegated to the bottom of priorities in national health systems. [ABSTRACT FROM AUTHOR]

Improving how individuals with type 2 diabetes look after their feet is reported to be one of the most effective strategies in minimising diabetic foot complications. This study evaluated foot care behaviour in people with type 2 diabetes living in Malta. Participants were grouped according to age (45–64 years [n=30] and ≥65 years [n=30]); the Nottingham Assessment of Functional Footcare (NAFF; Lincoln et al, 2007) was used to determine foot care behaviours in both groups. There was no significant difference in NAFF scores between the two groups (P=0.635); the mean NAFF score for the group aged 45–64 years was 55.43 and for the group aged ≥65 years was 54.73. Since the possible maximum NAFF score is 87, both groups showed suboptimal foot care behaviour in terms of footwear, hosiery and wound management. Healthcare professionals play an important part in helping individuals with diabetes improve their foot care behaviour and lifestyle to minimise foot complications. [ABSTRACT FROM AUTHOR]

It has been reported that foot examinations by healthcare professionals, together with appropriate educational initiatives, play a vital role in decreasing diabetic foot complications. A fuller understanding of the factors that contribute to suboptimal foot care, leading to costly diabetic complications, is important for improved outcomes. In this article, the authors highlight the importance of diabetes foot care education in primary care settings amongst people living with type 2 diabetes. [ABSTRACT FROM AUTHOR]

To investigate the relationship between diabetes-related knowledge and foot ulceration among people with type 2 diabetes, the authors assessed diabetes knowledge in groups with and without foot ulceration. There was no significant difference in diabetes-related knowledge between the two groups, although the mean level of knowledge in the group with foot ulceration was greater. The authors' question current approaches to diabetes education and suggest that anew approach to diabetes education programmes is needed. [ABSTRACT FROM AUTHOR]

Background The literature reports that people living with diabetes do not adhere to their prescribed therapeutic footwear as instructed. The reason for this is still uncertian although certain footwear characteristics seem to reasons reported leading to reduced level of adherence. Objectives To explore the reasons for current adherence or otherwise to prescribed stock footwear amongst patients living with type-2 diabetes. Methods An exploratory qualitative design method using an Interpretative Phenomenological Analysis [IPA] was employed in this research. Employing purposive sampling, twelve participants were recruited and interviewed. Interviews were recorded, transcribed and later analysed. Results Common themes that emerged from this study fell under 2 main categories including 'Adherence' and 'Non – Adherence' to wearing the prescribed stock footwear. A number of themes were identified with regards to the reasons for such adherence or otherwise by respective participants including footwear characteristics, service provision, peer pressure and the patient's knowledge and attitudes. Conclusion This study demonstrated suboptimal adherence to wearing therapeutic footwear among people with type 2 diabetes. Although the literature highlights the importance of adherence to therapeutic footwear in high risk populations for the prevention of diabetic foot complications, this study provides the reasons as to why patients still do not comply in wearing their prescribed therapeutic footwear. In order to improve behavioral changes patients would require on-going care, empowerment and support combined with educational programs to achieve a higher level of adherence. More research is warranted to explore further psychosocial interventions in diabetes care. [ABSTRACT FROM AUTHOR]

On‐water rowing is a sport where participants make extensive, powerful, and complex repetitive movements with their wrists to pull and feather (twist) the oar. Herein, the aim is to assess the frequency and perceived causes of wrist and forearm pain in rowers and, in particular, assess whether there are any possible mechanical issues that could be addressed through the use of auxetic technology. Through an online survey of 145 on‐water rowers, it is found that 33.8% of the rowers reported wrist or forearm pain arising from rowing. The majority (67.3%) consider over‐gripping to be the cause while one out of five associated it with periods of tension and anxiety, which also led them to over‐grip. This indicates that rowing handles could benefit from the use of mechanical metamaterials, auxetics in particular, owing to their anomalous manner in how they deform when subjected to mechanical deformations. Moreover, given the rise in popularity of coastal rowing, which will become an Olympic discipline alongside classic rowing as from the 2028 Los Angeles Olympic Games, the potential use of auxetics in the manufacture of protective gear for use in coastal rowing is also discussed. [ABSTRACT FROM AUTHOR]

Rowing is a sport that requires athletes to perform the action of pulling and rotating an oar by hand, applying forces of considerable magnitude. Herein, inspired by the notion that auxetic materials and metamaterials behave differently compared to their conventional counterparts, it is examined how a handle prototype, specifically designed to incorporate the classic re‐entrant motif, behaves and how end‐users perceive it. Physical experiments conducted on such prototype, which measured the contact pressures, suggest that on average, higher pressures are measured when pulling with this reentrant grip compared to its non reentrant counterpart, indicating that this re‐entrant prototype should feel firmer. More importantly, respondents of a survey are asked to give their feedback, and different views on which handle they would prefer to use are provided. The ones who preferred the prototype with the reentrant features report that they preferred it because it felt firmer and allowed for a better grip. This suggests that there is potential for further investigation into whether handles, oar handles in particular, made from auxetic components, re‐entrant cells, or other motifs which are well known for their negative Poisson's ratio characteristics, could provide a better and more secure grip and be used in sports applications. [ABSTRACT FROM AUTHOR]

This study compared subjective screening modalities recommended in diabetic foot screening guidelines for the detection of diabetic peripheral neuropathy (DPN) with an objective measure, the NC-Stat DPNCheck ® . We assessed 63 participants (mean age 54.5 years ± 10.5) utilising subjective screening tools (Semmes-Weinstein 10-g monofilament, 128-Hz traditional tuning fork, neurothesiometer, O'Brien 128-Hz electronic tuning fork) and compared results with the objective automated sural nerve conduction test NC-Stat DPNCheck ® . A significant difference was found in the number of limbs classified with DPN between all screening tools ( P  < .05). Therefore, this suggests that some screening modalities are more sensitive in diagnosing DPN than others, highlighting the importance of using multiple screening tools to a comprehensive understanding of the patient's neurological status. The findings also emphasize the need to incorporate objective measures in diabetic foot screening and encourage future research to establish a gold standard tool for DPN diagnosis., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The use of telemedicine has garnered significant traction amidst the COVID-19 pandemic. The sudden adoption of certain practices in podiatry was not always supported by empirical evidence, resulting in the development of guidelines and metrics that lacked a foundation in rigorous research., Methods: A modified Delphi composed of three rounds was conducted with 16 stakeholders (service users, foot and ankle health-care providers, and policymakers) from a primary-care setting to develop a podiatric telemedicine framework for a primary-care setting. The first round consisted of focus group discussions, the second round consisted of a questionnaire composed of different statements that emerged from focus group discussions, and the final third round consisted of a questionnaire with statements from the second round that required further reiterations. Statements that achieved an 80% or higher level of agreement were accepted to form part of the podiatric telemedicine framework., Results: Excellent consensus data was obtained to develop the podiatric telemedicine framework. Although podiatric telemedicine for low-risk patients in a primary-care setting is relatively new, stakeholders highlighted the importance of having podiatric telemedicine guidelines and setting service user and provider expectations clear on what podiatric telemedicine has to offer and its pitfalls., Conclusions: The podiatric telemedicine framework developed is recommended to all foot and ankle health-care professionals in a primary-care setting who wish to provide telemedicine consultations. Moreover, it is recommended that a pilot study be carried out to look into the feasibility of this framework being translated and implemented as a guideline related to foot and ankle telemedicine consultations.

Aims: Elevated plantar pressure is considered a significant risk factor for ulceration in diabetes mellitus. The aim of this study was to determine whether duration of diabetes could affect plantar pressure in patients with no known significant comorbidity or foot pathology., Methods: Participants with type 2 diabetes, but without known confounding factors that could alter peak pressure, were matched for age, weight, and gender and categorized into 3 groups of diabetes duration: group 1 (1-5 yr), group 2 (6-10 yr), and group 3 (11-15 yr). Plantar pressures were recorded utilizing a two-step protocol at a self-selected speed., Results: One-way analysis of variance (ANOVA) revealed significant differences in mean peak plantar pressures between the three groups under the 2 nd - 4 th metatarsophalangeal joint (MPJ) region of interest (ROI) (p = 0.012 and p = 0.022, respectively) and left heel (p = 0.049). Also, a significant difference in mean pressure-time integral under the left 2 nd - 4 th MPJ ROI (p = 0.021) and right heel (p = 0.048) was observed. Regression analysis confirmed that mean peak plantar pressures in the first group (but not in the second group) were significantly lower than in the third group (p = 0.005)., Conclusions: As the duration of diabetes increased, peak plantar pressure increased significantly under the 2 nd - 4 th MPJ ROIs. These findings suggest that clinicians should make more use of pressure mapping technology as part of their clinical management plan in patients with diabetes >10 yr, even if they have no complications or deformities, to preserve functional limbs in this high-risk population.

Thermal imaging can provide an image of the surface temperature of an object in a non-contact and noninvasive manner, making it particularly appealing for use in medical applications. In applications where it is desirable to extract temperature data from anatomical regions of interest (ROIs) in a standardised and consistent manner, the use of automated segmentation and analysis techniques can provide a faster, more reliable and more consistent approach than manual segmentation of these ROIs. In this paper we present an algorithm which automatically extracts temperature data from eight ROIs in thermal images of the volar aspect of human hands. The algorithm first identifies the hand from the background in the thermal image and then identifies pixels which make up the fingers and the palm. Finally, eight ROIs are extracted from the identified regions. The methods proposed in this work can also be extended for the processing of similar visual images.

Background: We sought to evaluate the relationship between baseline hemoglobin A 1c (HbA 1c ) level and clinical outcomes, including foot ulcer outcome (resolved versus unresolved) and wound-healing time, in individuals with type 2 diabetes., Methods: A prospective observational study was conducted on 99 patients presenting with a diabetic foot ulceration. Patient and ulcer characteristics were recorded. Patients were followed up for a maximum of 1 year., Results: After 1 year of follow-up, 77% of ulcers healed and 23% did not heal. Although this study demonstrated that the baseline HbA 1c reading was not a significant predictor of foot ulcer outcome (P = .603, resolved versus amputated), on further statistical analyses, when HbA 1c was compared with the time taken for complete ulcer healing in the resolved group (n = 77), it proved to be significant (P = .009)., Conclusions: These findings have important implications for clinical practice, especially in an outpatient setting. Improving glycemic control may improve ulcer outcomes. Prediction of outcome may be helpful for health-care professionals in individualizing and optimizing clinical assessment and management of patients. Identification of determinants of outcome could result in improved health outcomes, improved quality of life, and fewer diabetes-related foot complications.

Introduction: Several treatment modalities and protocols for arterial wound ulcers are available; however, little consensus exists on which treatment modality provides the best results. The present study sought to compare and evaluate the clinical efficacy of vacuum-assisted closure wound therapy to calcium alginate dressings in the treatment of neuroischemic diabetic foot ulceration., Material and Methods: A single-center quasi-experimental matched subject clinical trial was conducted on 30 subjects living with type 2 diabetes and presenting with a newly diagnosed neuroischemic foot ulceration. Subjects were divided into 2 groups. Group A (n = 15) underwent negative pressure wound therapy and Group B (n =15) underwent treatment using calcium alginate dressings. Ulcer area and depth were measured during the trial., Results: Both negative pressure therapy and calcium alginate dressings were effective in reducing the surface area and depth of ulcers (P = 0.0001). However, negative pressure was 3.2 times more effective in reducing surface area and 3.78 times more effective in reducing depth of ulcers when compared to calcium alginate (P = 0.0001)., Conclusion: Vacuum-assisted closure should be considered as the treatment of choice for neuroischemic ulceration owing to its advantages in reducing surface area and depth when compared to calcium alginate dressings. Improved care could result in improved health outcomes, improved quality of life, and fewer diabetes-related foot complications.