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Abstract Benefits of neural mobilization (NM) have been described in musculoskeletal patients. The effects of NM on balance appear to be unclear in research, and no studies have tested the possible effects of NM on plantar pressures. Eighteen subjects were evaluated pre and post bilateral gliding of the sciatic nerve and its branches posterior tibial nerve, lateral dorsocutaneous, medial and intermediate dorsocutaneous nerves. Static variables of the plantar footprint and stabilometric variables were measured in a pre-post study. We found no differences in plantar pressure variables, Rearfoot maximum pressure (p = 0.376), Rearfoot medium pressure (p = 0.106), Rearfoot surface (p = 0.896), Midfoot maximum pressure (p = 0.975), Midfoot medium pressure (p = 0.950), Midfoot surface (p = 0.470) Forefoot maximum pressure (p = 0.559), Forefoot medium pressure(p = 0.481), Forefoot surface (p = 0.234), and stabilometric variables either, X-Displacement eyes-open (p = 0.086), Y-Displacement eyes-open (p = 0.544), Surface eyes-open (p = 0.411), Medium speed latero-lateral displacement eyes-open (p = 0.613), Medium speed anteroposterior displacement eyes-open (p = 0.442), X Displacement eyes-closed (p = 0.126), Y-Displacement eyes-closed (p = 0.077), Surface eyes-closed (p = 0.502), Medium speed latero-lateral displacement eyes-closed (p = 0.956), Medium speed anteroposterior displacement eyes-closed (p = 0.349). All variables don´t have significant differences however the measurements had a high reliability with at least an ICC of 0.769. NM doesn´t change plantar pressures or improve balance in healthy non-athletes subjects. NCT05190900.

The aim of the present study was to determine the gender respiratory differences of bilateral diaphragm thickness, respiratory pressures, and pulmonary function in patients with low back pain (LBP). A sample of 90 participants with nonspecific LBP was recruited and matched paired by sex (45 women and 45 men). Respiratory outcomes included bilateral diaphragm thickness by ultrasonography, respiratory muscle strength by maximum inspiratory (MIP) and expiratory (MEP) pressures, and pulmonary function by forced expiratory volume during 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC spirometry parameters. The comparison of respiratory outcomes presented significant differences (p < 0.001), with a large effect size (d = 1.26–1.58) showing means differences (95% CI) for MIP of −32.26 (−42.99, −21.53) cm H2O, MEP of −50.66 (−64.08, −37.25) cm H2O, FEV1 of −0.92 (−1.18, −0.65) L, and FVC of −1.00 (−1.32, −0.69) L, with lower values for females versus males. Gender-based respiratory differences were presented for maximum respiratory pressures and pulmonary function in patients with nonspecific LBP. Women presented greater inspiratory and expiratory muscle weakness as well as worse lung function, although these differences were not linked to diaphragm thickness during normal breathing.

Background: there is a high risk of falls in older adults. One of the factors contributing to fall episodes is advancing age due to deterioration of the proprioceptive system. Certain clinical procedures improve balance and posture, such as the use of insoles. Objective: the objective of this study was to evaluate the impact of hard and soft insoles on static foot balance in healthy older adults compared to barefoot people. Methods: a clinical trial was conducted with a sample size of 150 healthy adults (69 male and 81 women) with a mean age of 69.03 ± 3.82 years. Postural control was evaluated in different conditions of barefoot balance with hard and soft insoles. Results: All tests were statistically significant (p < 0.001). The test with soft insoles presented higher stabilometric values and presented worse postural control compared to the barefoot and hard insoles in all eyes-open and eyes-closed conditions. Conclusions: Hard and soft insoles show no improvement in postural control compared to barefoot standing. The findings suggest that soft insoles may result in impaired balance during standing. The density of the materials in the insoles emerges as a significant factor influencing postural control.

Introduction: The aim of the present study was to determine the effectiveness of simultaneous bilateral visual diaphragm biofeedback (BFB) from ultrasonography in conjunction with inspiratory muscle training (IMT) on diaphragmatic thickness during normal breathing and respiratory and clinical outcomes in patients with non-specific low back pain (NSLBP) and determine the influence of age and sex.Methods: A single-blind randomized clinical trial was carried out (NCT04582812). A total sample of 96 patients with NSLBP was recruited and randomized by sex-based stratification into IMT (n = 48) and BFB + IMT (n = 48) interventions over 8 weeks. Bilateral diaphragmatic thickness at maximum inspiration (Tins) and expiration (Texp), respiratory pressures, lung function, pain intensity, bilateral pressure pain threshold (PPT), disability, and quality of life were measured at baseline and after 8 weeks.Results: The BFB + IMT group showed significant differences (p < 0.05) with increased left hemidiaphragm thickness at Tins and Tins-exp (d = 0.38–053), and right and left PPT (d = 0.71–0.74) versus the IMT group. The interaction with sex was statistically significant (p = 0.007; F(1,81) = 7.756; ηp2 = 0.087) and higher left hemidiaphragm thickness at Tins was predicted by the BFB + IMT group (R2 = 0.099; β = 0.050; F(1,82) = 8.997; p = 0.004) and male sex (R2 = 0.079; β = 0.045; F(1,81) = 7.756;p = 0.007). Furthermore, greater left hemidiaphragm thickness at Tins-exp was predicted by younger age (R2 = 0.052; β = −0.001; F(1,82) = 4.540; p = 0.036).Discussion: The simultaneous bilateral visual diaphragm biofeedback by ultrasonography in conjunction with IMT was effective in both increasing the left diaphragmatic thickness during inspiration, which was positively influenced and predicted by male sex and younger age, and increasing the bilateral PPT of the paraspinal muscles in patients with NSLBP.

Abstract Background The coronavirus 2019 (COVID-19) pandemic has prompted several changes in the learning methods of students. The purpose of this study was to establish whether a relationship between levels of resilience, self-esteem, anxiety, depression, and academic stress in both hybrid and virtual learning education exist. Methods A descriptive and observational case-control study was carried out in universities that offer nursing designation. A total sample of 140 freshman nursing students was recruited. Concretely, 70 participants were recruited from an university receiving hybrid education and 70 participants were recruited from another university receiving virtual learning education. Nursing students self-reported the following questionnaires: the Rosenberg Self-Esteem scale, the 10 CD-Risk Connor-Davidson Risk Resilience Scale, the Beck Anxiety Inventory, the Beck Depression Inventory and the Academic Stress Coping Scale. Results Significant differences (P = 0.001) showed higher depression levels for students who received virtual education versus received hybrid education. Differences in Rosenberg test for self-esteem and Beck Anxiety Inventory for anxiety (P > 0.05) were not found. Conclusion Students who received online education presented higher depression levels which could be due to they had not face-to-face relationships with teachers or classmates, whereas the hybrid education group received a different type of direct interaction with teachers and peers.

Background Infrared thermography devices have been commonly applied to measure superficial temperature in structural composites and walls. These tools were cheaper than other thermographic devices used to measure superficial human muscle tissue temperature. In addition, infrared thermography has been previously used to assess skin temperature related to muscle tissue conditions in the triceps surae of athletes. Nevertheless, the reliability and repeatability of an infrared thermography device designed for materials, such as the Manual Infrared Camera PCE-TC 30, have yet to be determined to measure skin temperature of the triceps surae muscle tissue of athletes. Objective The purpose was to determine the procedure’s intra- and inter-session reliability and repeatability to determine skin temperature within the Manual Infrared Camera PCE-TC 30 thermography device in the triceps surae muscle tissue of athletes, which was initially designed to measure the superficial temperature of materials. Methods A total of 34 triceps surae muscles were bilaterally assessed from 17 healthy athletes using the Manual Infrared Camera PCE-TC 30 thermography device to determine intra- (at the same day separated by 1 h) and inter-session (at alternate days separated by 48 h) reliability and repeatability of the skin temperature of the soleus, medial and lateral gastrocnemius muscles. The triceps surae complex weas measured by a region of interest of 1 cm2 through five infrared thermography images for each muscle. Statistical analyses comprised intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MCD), systematic error of measurement, correlation (r), and Bland-Altman plots completed with linear regression models (R2). Results Intra- and inter-session measurements of the proposed infrared thermography procedure showed excellent reliability (ICC(1,2) = 0.968–0.977), measurement errors (SEM = 0.186–0.232 °C; MDC = 0.515–0.643 °C), correlations (r = 0.885–0.953), and did not present significant systematic error of measurements (P > 0.05). Adequate agreement between each pair of measurement moments was presented by the Bland-Altman plots according to the limits of agreement and non-significant linear regression models (R2 = 0.000–0.019; P > 0.05). Conclusions The proposed procedure to determine skin temperature within the Manual Infrared Camera PCE-TC 30 thermography device presented excellent intra- and inter-session reliability and repeatability in athletes’ triceps surae muscle tissue. Future studies should consider the SEM and MDC of this procedure to measure the skin temperature of soleus, medial, and lateral gastrocnemius muscles to promote triceps surae muscle prevention and recovery in athletes.

Background: The myofascial induction technique (MIT) has been shown to increase shoulder range of motion (ROM) in breast cancer survivors and decrease pain pressure threshold over the radial nerve in patients with epicondylalgia. To the authors’ best knowledge, no study on trigger points and MIT has been published to date. The effect on ROM of latent trigger points is also unknown. Methods: A total of 20 twins with one latent trigger point of the gastrocnemius muscle were evaluated pre- and post-MIT in the calf. We measured static footprint variables in a pre–post study. Results: We found differences in PPT (p = 0.001) and no differences in ROM with knee flexed (p = 0.420) or stretched (p = 0.069). Conclusions: After Calf MIT, latent myofascial trigger points improve PPT but no change in ankle dorsiflexion with knee bent or knee flexed were found in non-restriction healthy subjects.

Chronic ankle instability (CAI) is a common pathology in handball. The role of the intrinsic musculature of the foot in these players in relation to proprioception and stability has not been stablished. The objective of this study was to compare the ultrasound morphology of the heel fat pad of the foot in professional handball players to CAI in healthy players and establish relationships between CAI and physical and psychological variables. The study has been a descriptive observational case–control study in which 20 professional handball male players over 18 years of age were divided into 8 cases (CAI) and 12 controls (healthy). An ultrasound evaluation, the thickness and/or cross-sectional area at rest and the contraction measurement of the Abductor Digiti Minimi, Abductor Hallucis, Flexor Digitorum Brevis and Quadratus Plantae muscles were analyzed. Moreover, the compressibility index of the heel fat pad and the activation of the abdominal wall musculature (ultrasound), the flexion strength of the hallux and lesser toes (dynamometry), the foot functionality (Bristol Foot Score (BFS) questionnaire) and the psychological variables (self-reported questionnaires) were measured. There were no significant differences between the activation capacity values of the foot muscles of healthy and CAI athletes. Significant differences were found between groups regarding the BFS score (p = 0.007), d = 1.404), and significant correlations were also found between hallux flexion strength and lesser toes flexion strength in the total sample. Although there were no differences between the two groups, the identification of the activation pattern of these muscles in handball athletes is essential to the improvement of performance and preventing injuries such as CAI.

Deep dry needling (DDN) and percutaneous electrolysis (PE) provide the benefit of the mechanical effect of the needle, and PE adds the potential advantages of the galvanic current it incorporates in myofascial trigger points (MTrPs) therapy. The aim of this study was to compare the short-term efficacy between PE and DDN on active MTrPs of the levator scapulae by considering pain intensity. A simple-blind randomized controlled trial was carried out, recruiting patients suffering from non-specific neck pain lasting more than 3 months and with active MTrPs in the levator scapulae muscle (n = 52). Patients were divided into intervention (PE; n = 26) and control (DDN; n = 26) groups and received one treatment session on the active MTrPs of the levator scapulae. Patients were assessed for pain intensity, pressure pain threshold (PPT), cervical range of motion (CROM), neck disability and post-needling soreness, immediately after treatment, at 72 h and at 14 days. In addition, pain during treatment was recorded after the procedure. There were no significant differences for pain intensity, post-needling soreness and PPT. We found significant differences in CROM, immediately after treatment (p = 0.043), and at 72 h (p = 0.045), in favor of the PE group. Significant differences were found for neck disability (p < 0.047), immediately post-treatment, in favor of the DDN group. Moreover, there were significant differences for pain during the intervention (p < 0.002), in favor of the DDN group (4.54 ± 2.21) versus the PE group (6.54 ± 2.27). PE and DDN appear to have similar short-term effects. PE proved to be a more painful treatment than DDN. Clinical trial registry: NCT04157426.

It has been reported that the new technology applied to current racing shoes has increased the performance of runners who use this kind of footwear. This improvement has been proven in the scientific literature in relation to oxygen consumption. Nevertheless, as it is a novel topic, there is a lack of knowledge about which specific features achieve a decrease in oxygen consumption during running. Thus, the purpose of this study was to determine the influence of the features of footwear, specifically the shoe mass, the cushioning system, the longitudinal bending stiffness and the comfort feeling on running economy. This review was carried out from the bibliographic search in the main databases such as PubMed, Cochrane Plus and Medline and considering the PRISMA statement as a reference so that an analysis of the results has been obtained together with the methodological quality and risk of bias of the studies. Nineteen articles met the inclusion criteria, which presented a moderate/high methodological quality, and an analysis of their results was carried out. Footwear features such as the shoe mass, the cushioning system and the longitudinal bending stiffness produce advantages compared to other footwear that does not include this technology. Due to the lack of evidence, the influence of comfort feeling on oxygen consumption has not been proved.

Worldwide, healthcare systems had to respond to an exponential increase in COVID-19 patients with a noteworthy increment in intensive care units (ICU) admissions and invasive mechanical ventilation (IMV). The aim was to determine low intensity respiratory muscle training (RMT) effects in COVID-19 patients upon medical discharge and after an ICU stay with IMV. A retrospective case-series study was performed. Forty COVID-19 patients were enrolled and divided into twenty participants who received IMV during ICU stay (IMV group) and 20 participants who did not receive IMV nor an ICU stay (non-IMV group). Maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), COPD assessment test (CAT) and Medical Research Council (MRC) dyspnea scale were collected at baseline and after 12 weeks of low intensity RMT. A greater MRC dyspnea score and lower PImax were shown at baseline in the IMV group versus the non-IMV group (p < 0.01). RMT effects on the total sample improved all outcome measurements (p < 0.05; d = 0.38–0.98). Intragroup comparisons after RMT improved PImax, CAT and MRC scores in the IMV group (p = 0.001; d = 0.94–1.09), but not for PImax in the non-IMV group (p > 0.05). Between-groups comparison after RMT only showed MRC dyspnea improvements (p = 0.020; d = 0.74) in the IMV group versus non-IMV group. Furthermore, PImax decrease was only predicted by the IMV presence (R2 = 0.378). Low intensity RMT may improve respiratory muscle strength, health related quality of life and dyspnea in COVID-19 patients. Especially, low intensity RMT could improve dyspnea level and maybe PImax in COVID-19 patients who received IMV in ICU.

Coronary artery disease (CAD) may be considered a main cause of mortality and the prevalence of CAD is increasing nowadays, leading to high health costs in many countries. Despite the fact of the regression of the atherosclerotic plaque, the decrease in blood viscosity and the growth of collateral vessels have been proposed as improvements that CAD patients may obtain under exercise performance. Thus, the present narrative review aimed to carry out a brief specific analysis of the results achieved when performing endurance, strength or inspiratory muscle training. Exercise attenuates certain pathophysiological processes of this disease, such as endothelial dysfunction or the vulnerability of atherosclerotic plaques, and produces improvements in functional capacity and muscle strength, among others. Within the different exercise modalities, the most important parameter to be considered seems to be the total caloric expenditure, and not so much the modality itself. As such, in cardiac rehabilitation, when prescribing exercise, we should possibly focus on the modality that obtains more adherence in patients. To conclude, it must be highlighted that total caloric expenditure is not being taken into account when comparing interventions and this relevant information should be considered in future studies.

Abstract Background This study determined if the body mass index, dynamic plantar-pressures, plantar surface contact-area, velocity of the centre of pressure (COP), gastrocnemius equinus, and gastrocnemius soleus equines are related to calcaneal apophysitis (Sever’s disease) in athletic children. Methods This case-control study examined 106 boys enrolled in a soccer academy, including 53 with Sever’s disease and 53 age-matched healthy controls. The dynamic average and maximum peak plantar-pressures, plantar surface contact-area, and velocity of the COP were evaluated with a digital pressure sensor platform. Goniometry was used to measure the ankle dorsiflexion range of motion and thereby identify gastrocnemius equinus and gastrocnemius soleus equinus. Results Participants with Sever’s condition had significantly higher BMI and peak plantar-pressures (maximum and average) at the heel (Cohen’s d > 3 for pressures) than the controls. Those with Sever’s disease also had significantly slower velocity of the COP (Cohen’s d > 3). Boys with Sever’s disease were also 8 times more likely to have bilateral gastrocnemius equinus than disease controls. Conclusions High heel plantar pressure and low velocity of COP are related to Sever’s condition in boys, although it is not clear whether these factors predispose individuals to the disease or are consequences of the disease. Gastrocnemius ankle equinus could be a predisposing factor for Sever’s condition.

Abstract Background The aim of this study was to explore students’ perceptions of the educational environment (EE) in a Spanish school of podiatry. Various aspects of EE were compared by academic year in the program. Methods This was a cross-sectional study using a questionnaire to collect perceptions using data from a 2015 survey. Podiatric medical students from Extremadura University participated in this study. EE was assessed with the Dundee Ready Education Environment Measure (DREEM) tool. The DREEM questionnaire covers five domains of student perceptions, including learning, teachers, academic self-perceptions, atmosphere, and social self-perceptions. Results Two hundred thirty-five students participated, resulting in a 90.73% response rate. Participants included similar numbers of students from different years in the program, and most were women. The global EE score was 2.58 out of 4, indicating that students’ perceptions were more positive than negative. Although some weaknesses were detected in this school, students viewed the EE positively in all five DREEM domains. Academic year in the program were generally not related to perceptions of EE. Conclusions Podiatric medical students declared, in general, that the EE was more positive than negative in our school, according to the DREEM questionnaire. However, although the results are on the whole good, some areas need to be revised to make improvements.

In response to the current state of the COVID-19 pandemic, healthcare providers are using common surgical masks and filtering respirators in conjunction with the presence of facial hair, which could lead to a large number of particles passing into their respiratory system. The purpose of this study was to determine the fit factor effectiveness of filtering respirators and surgical masks in bearded versus non-bearded healthcare providers. A controlled randomized clinical trial (NCT04391010) was carried out, analyzing a sample of 63 healthcare providers. The fit factors of surgical masks and FFP3 filtering respirators for healthcare providers with (n = 32) and without (n = 31) facial hair were compared. Fit factors were measured during an exercises protocol in which healthcare providers wore surgical masks and FFP3 filtering respirators. Surgical mask fit factor comparisons did not show significant differences (p > 0.05) between healthcare providers with and without facial hair. In contrast, filtering respirator fit factor comparisons showed statistically significant differences (p < 0.01) between both groups, indicating that healthcare providers with facial hair showed lower fit factor scores, which implies a worse fit factor with respect to healthcare providers without facial hair. The fit factor effectiveness of filtering respirators was reduced in healthcare providers with facial hair. The authors of this paper encourage healthcare providers to trim their beards during filtering respirator use or wear full-mask filtering facepiece respirators, especially during the COVID-19 pandemic.

The use of rehabilitative ultrasound imaging (RUSI) to evaluate diaphragm thickness during breathing in athletes who suffer from non-specific lumbopelvic pain presents some measurement errors. The purpose of this study was to evaluate intra- and inter-sessions, intra- and inter-rater reliabilities, and concurrent validity of diaphragm thickness measurements during breathing using transcostal RUSI with a novel thoracic orthotic device that was used to fix the US probe versus those measurements obtained using manual fixation. A total of 37 athletes with non-specific lumbopelvic pain were recruited. Intra- (same examiner) and inter-rater (two examiners) and intra- (same day) and inter-session (alternate days) reliabilities were analyzed. All measurements were obtained after manual probe fixation and after positioning the thoracic orthotic device to fix the US probe in order to correctly correlate both measurement methods. Both left and right hemi-diaphragm thickness measurements were performed by transcostal RUSI at maximum inspiration, expiration, and the difference between the two parameters during relaxed breathing. Intra-class correlation coefficients (ICC), standard errors of measurement (SEM), minimum detectable changes (MCD), systematic errors, and correlations (r) were assessed. Orthotic device probe fixation showed excellent reliability (ICC = 0.852–0.996, SEM = 0.0002–0.054, and MDC = 0.002–0.072), and most measurements did not show significant systematic errors (p > 0.05). Despite manual probe fixation with a reliability ranging from good to excellent (ICC = 0.714–0.997, SEM = 0.003–0.023, and MDC = 0.008–0.064 cm), several significant systematic measurement errors (p < 0.05) were found. Most significant correlations between both orthotic device and manual probe fixation methods were moderate (r = 0.486–0.718; p < 0.05). Bland–Altman plots indicated adequate agreement between both measurement methods according to the agreement limits. The proposed novel thoracic orthotic device may allow ultrasound probe fixation to provide valid and reliable transcostal RUSI measurements of diaphragmatic thickness during relaxed breathing thus reducing some measurement errors and avoiding systematic measurement errors. It may be advisable to measure diaphragm thickness and facilitate visual biofeedback with respect to diaphragm re-education during normal breathing in athletes with non-specific lumbopelvic pain.

Several studies have shown that gastrocnemius is frequently injured in triathletes. The causes of these injuries are similar to those that cause the appearance of the myofascial pain syndrome (MPS). The ischemic compression technique (ICT) and deep dry needling (DDN) are considered two of the main MPS treatment methods in latent myofascial trigger points (MTrPs). In this study superficial electromyographic (EMG) activity in lateral and medial gastrocnemius of triathletes with latent MTrPs was measured before and immediately after either DDN or ICT treatment. Taking into account superficial EMG activity of lateral and medial gastrocnemius, the immediate effectiveness in latent MTrPs of both DDN and ICT was compared. A total of 34 triathletes was randomly divided in two groups. The first and second groups (n = 17 in each group) underwent only one session of DDN and ICT, respectively. EMG measurement of gastrocnemius was assessed before and immediately after treatment. Statistically significant differences (p = 0.037) were shown for a reduction of superficial EMG measurements differences (%) of the experimental group (DDN) with respect to the intervention group (ICT) at a speed of 1 m/s immediately after both interventions, although not at speeds of 1.5 m/s or 2.5 m/s. A statistically significant linear regression prediction model was shown for EMG outcome measurement differences at V1 (speed of 1 m/s) which was only predicted for the treatment group (R2 = 0.129; β = 8.054; F = 4.734; p = 0.037) showing a reduction of this difference under DDN treatment. DDN administration requires experience and excellent anatomical knowledge. According to our findings immediately after treatment of latent MTrPs, DDN could be advisable for triathletes who train at a speed lower than 1 m/s, while ICT could be a more advisable technique than DDN for training or competitions at speeds greater than 1.5 m/s.

Background: Walking clinical assessments are commonly used to check for possible gait modifications in healthy subjects, in patients with trauma or neurological conditions, or after a surgical procedure. Spatio-temporal walking variables are studied in depth to achieve a complete evaluation. The purpose of this study was to perform an observational study of the reliability and repeatability of the OptoGait portable photoelectric cell system. Methods: An observational study of the reliability and repeatability of the OptoGait portable photoelectric cell system was carried out. Results: Walking point, walking point gap, step width, and walking base variables, which are deeply related to gait and posture, have an almost perfect reliability. Conclusion: The OptoGait motion analysis device is a reliable system for clinical assessment of static and dynamic foot pressures. Clinicians should feel confident adding this analysis system to their daily professional tools where repeatable measures of gait measurements are important for diagnosis and treatment selection, and also compare efficacy or testing differences between different pathologic conditions. Further, these obtained data can be formed as a baseline for future studies, and to check a right sample size for new research that use the OptoGait motion analysis system.

Ankle sprains have been defined as the most common injury in sports. The aim of the present study was to investigate the ankle taping for the reduction of ankle dorsiflexion range of motion (ROM) and inter-limb in elite soccer and basketball players U18 in a single training session. Methods: A cross-sectional pilot study was performed on 38 male healthy elite athletes divided into two groups: a soccer group and a basketball group. Ankle dorsiflexion ROM and inter-limb asymmetries in a weight-bearing lunge position were assessed in three points: with no-tape, before the practice and immediately after the practice. Results: For the soccer group, significant differences (p < 0.05) were observed for the right ankle, but no differences for the asymmetry variable. The basketball group reported significant differences (p < 0.05) for the right ankle and symmetry. Conclusions: Ankle taping decreased the ankle dorsiflexion ROM in youth elite soccer and basketball players U18. These results could be useful as a prophylactic approach for ankle sprain injury prevention. However, the ankle ROM restriction between individuals without taping and individuals immediately assessed when the tape was removed after the training was very low.

Background: This study aimed to adapt the Spanish version of the Assessment of Stress in Nursing Students (ASNS) (shorter form) instrument for Spanish podiatry students, labeling the new tool as the Spanish version of Assessment of Stress in Podiatry Students (ASPS). The adaptation for reliability and repeatability included performing the transcultural adaptation process and examining the repeatability and reliability of ASPS when used in a different language. Methods: An internationally recommended translation procedure was used to adapt transculturally this tool. The instrument’s test–retest reliability was evaluated in two sessions that were 10 days apart. Results: After considering each domain’s total score, the reliability and internal consistency were analyzed with Cronbach’s α and intraclass correlation coefficient for a 95% confidence interval. Good internal consistency was reported according to total score (α = 0.8626) and each one of the six domains: (1) the practical activities performance domain showed a Cronbach’s α of 0.8684; (2) professional communication domain, α = 0.8765; (3) time management domain, α = 0.8832; (4) environment domain, α = 0.8974; (5) professional education domain, α =0.873; and (6) theoretical activity domain, α = 0.8787. Test–retest reliability, by paired test of Wilcoxon, was not significant, showing that there were not differences between domain scores (p ≥ 0.05). Lastly, visual distributions of Bland and Altman plots did not provide differences between domains and total scores. Conclusions: The Spanish version of the ASPS showed good repeatability, reliability and acceptability to measure stress parameters for podiatry students.

The fibularis tertius muscle (FTM) is a rare anatomic variation. The prevalence of this exclusively human structure, which is found in the anterior compartment of the leg, is often underestimated, and it is believed that foot and ankle conditions are more difficult to manage in patients with an FTM. The aim of this study was to assess the presence of the FTM palpation and determine whether its presence is associated with an individual's sex, because the exact prevalence in males and females is unclear. An observational cross-sectional study was carried out. The study included 481 people (23.49% men and 76.51% women) with a mean age of 23.51±5.369 years, who were recruited from a Podiatric Medicine and Surgery Clinic (Spain). Data on routine demographic and clinical factors were recorded, and the presence or absence of the FTM was determined based on surface visual or palpated localization of the tendon (using a consistent protocol). The FTM was present in 38.25% (184/481) of the participants. Furthermore, FTM were present in 38.6% (142/481) of females and 37.2% (42/481) of males. The study revealed that the presence of the FTM varies between individuals and does not depend on an individual's sex. Significant differences in the prevalence of the FTM between countries should be carefully evaluated rather than generalizing the results of this Spanish study to other non-Spanish populations. Larger numbers of participants should be enrolled in future studies in order to meet the statistical criteria.

Background: Anatomic and histological landmarks of the extensor digitorum longus (EDL) tendon insertion in the proximal nail matrix may be key aspects during surgery exposure in order to avoid permanent nail deformities. Objective: The main purpose was to determine the anatomic and histological features of the EDL’s insertion to the proximal nail matrix of the second toe. Methods: A sample of fifty second toes from fresh-frozen human cadavers was included in this study. Using X25-magnification, the proximal nail matrix limits and distal EDL tendon bony insertions were anatomically and histologically detailed. Results: The second toes’ EDLs were deeply located with respect to the nail matrix and extended superficially and dorsally to the distal phalanx in all human cadavers. The second toe distal nail matrix was not attached to the dorsal part of the distal phalanx base periosteum. Conclusions: The EDL is located plantar and directly underneath to the proximal nail matrix as well as dorsally to the bone. The proximal edge of the nail matrix and bed in human cadaver second toes are placed dorsally and overlap the distal EDL insertion. These anatomic and histological features should be used as reference landmarks during digital surgery and invasive procedures.

Background and Objectives: The purpose of the present study was to quantify and compare lateral abdominal musculature thickness, including the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, via rehabilitative ultrasound imaging (RUSI) during the use of the expiratory flow control device (EFCD) versus the classic abdominal drawing-in maneuver (ADIM). Materials and Methods: A cross-sectional observational pilot study. Twenty-one women were recruited and assessed the thickness of each muscle (TrA, IO, and EO) by ultrasound imaging at rest, during the ADIM, and during expiration with the EFCD. Waist circumference was also measured under the same circumstances. Results: Statistically significant differences were observed between ADIM, EFCD, and at rest condition for the thickness of the TrA (p = 0.001) and IO (p = 0.039). Moreover, statistically significant differences for TrAb at rest compared with the ADIM (p = 0.001, Cohen’s d = 2.183) and at rest and with the EFCD (p = 0.001, Cohen’s d = 2.843). In addition, between ADIM and EFCD were not statistically significant, although a moderate effect size was found (p = 0.055, Cohen’s d = 0.694). For the IO muscle thickness, significant differences were reported between the EFCD and at rest (p = 0.038), Cohen’s d = 0.081). Conclusions: Significant differences in the increase of the thickness of the TrA and IO muscles during the use of the EFCD and the ADIM with respect to rest. In addition, for the TrA, statistically significant differences were found during expiration with the EFCD with respect to the ADIM. Expiration with EFCD can be a useful method for the activation of the TrA.

ABSTRACT BACKGROUND: Foot problems are believed to reduce quality of life and are increasingly present. Even among young adults of university age, untreated foot problems can lead to postural and mobility problems. Accordingly, our aim here was to determine the relationship between foot health and quality of life and general health among male and female university students. DESIGN AND SETTING: Observational cross-sectional quantitative study conducted at the Podiatric Medicine and Surgery Clinic of the University of Coruña, Ferrol, Spain. METHODS: A sample of 112 participants of median age 22 years came to a health center, where self-reported data were registered, including professional activity, and scores obtained through the Foot Health Status Questionnaire (FHSQ) were compared. RESULTS: In Section One of the FHSQ, the university students recorded lower scores of 66.66 in the footwear domain and 60 in the general foot health domain and higher scores of 84.37 in the foot pain domain and 93.75 in the foot function domain. In Section Two, they obtained lower scores of 60 in the overall health domain and 62.50 in the vigor domain and higher scores of 100 in the physical activity and 87.50 in the social capacity domain. Differences between males and females were evaluated using the Wilcoxon rank-sum test, which showing statistical significance (P < 0.05) regarding the dimensions of footwear and general foot health. CONCLUSIONS: These university students’ quality of life relating to foot health was poor. This appears to be associated with the university period, regardless of gender.

Gastrocnemius-soleus equinus (GSE) is a foot-ankle complaint in which the extensibility of the gastrocnemius (G) and soleus muscles (triceps surae) and ankle are limited to a dorsiflexion beyond a neutral ankle position. The asymmetric forces of leg muscles and the associated asymmetric loading forces might promote major activation of the triceps surae, tibialis anterior, transverses abdominal and multifidus muscles. Here, we made infrared recordings of 21 sportsmen (elite professional soccer players) before activity and after 30 min of running. These recordings were used to assess temperature modifications on the gastrocnemius, tibialis anterior, and Achilles tendon in GSE and non-GSE participants. We identified significant temperature modifications among GSE and non-GSE participants for the tibialis anterior muscle (mean, minimum, and maximum temperature values). The cutaneous temperature increased as a direct consequence of muscle activity in GSE participants. IR imaging capture was reliable to muscle pattern activation for lower limb. Based on our findings, we propose that non-invasive IR evaluation is suitable for clinical evaluation of the status of these muscles.

Purpose: To compare and quantify with ultrasound imaging (USI) the inter-recti distance (IRD), rectus abdominis (RA), external oblique (EO), internal oblique (IO), transversus abdominis (TrAb), and multifidus thickness and the RA and multifidus cross-sectional area (CSA) between individuals with and without chronic mid-portion Achilles tendinopathy (AT). Methods: A cross-sectional study. A sample of 143 patients were recruited and divided into two groups: A group comprised of chronic mid-portion AT (n = 71) and B group composed of healthy subjects (n = 72). The IRD, RA, EO, IO, TrAb, and multifidus thickness, as well as RA and multifidus CSA, were measured by USI. Results: USI measurements for the EO (p = 0.001), IO (p = 0.001), TrAb (p = 0.041) and RA (p = 0.001) thickness were decreased as well as IRD (p = 0.001) and multifidus thickness (p = 0.001) and CSA (p = 0.001) were increased for the tendinopathy group with respect the healthy group. Linear regression prediction models (R2 = 0.260 − 0.494; p < 0.05) for the IRD, RA, EO, and IO thickness (R2 = 0.494), as well as multifidus CSA and thickness were determined by weight, height, BMI and AT presence. Conclusions: EO, IO, TrAb, and RA thickness was reduced and IRD, multifidus thickness and CSA were increased in patients with AT.

Background and Objectives: Foot problems may be considered to be a prevalent condition and impact the health-related quality of life (QoL). Considering these Spanish-validated tools, the Foot Health Status questionnaire (FHSQ) may provide a health-related QoL measurement for specific foot conditions and general status. To date, the domains of the FHSQ and Medical Outcomes Study Short Form 36 (SF-36) have not been correlated. Therefore, the main aim of this study was to correlate the domains of the FHSQ and SF-36 in patients with foot problems. Materials and Methods: A cross-sectional descriptive study was carried out. A sample of 101 patients with foot problems was recruited. A single researcher collected descriptive data, and outcome measurements (FHSQ and SF-36) were self-reported. Results: Spearman’s correlation coefficients (rs) were calculated and categorized as weak (rs = 0.00−0.40), moderate (rs = 0.41−0.69), or strong (rs = 0.70−1.00). In all analyses, statistical significance was considered with a p-value < 0.01 with a 99% confidence interval. Statistically significant differences (p < 0.01) were found between all domains of FHSQ and SF-36, except for the mental health domain of the SF-36 with foot pain, foot function, and general foot health of the FHSQ, as well as between the vitality domain of the SF-36 and the general foot health domain of the FHSQ (p > 0.01). Statistically significant correlations varied from week to strong (rs = 0.25−0.97). The strongest correlations (p < 0.001) were found for physical activity and physical function (rs = 0.94), vigor and vitality (rs = 0.89), social capacity and social function (rs = 0.97), and general health domains of the SF-36 and FHSQ. Conclusions: The FHSQ and SF-36 showed an adequate concurrent validity, especially for the physical activity or function, vigor or vitality, social capacity or function, and general health domains. Nevertheless, the mental health domain of the SF-36 should be considered with caution.

Some studies suggest that gender is related to gait. Females show significantly higher ankle motion and vertical ground reaction forces. Males have significantly larger plantar contact surface areas in all regions of the foot than females in most, but not all, prior studies. However, there is no research on sex differences in a functional equinus condition. In this study, 119 individuals, including 59 females (29.7 ± 5.15 years, 58.74 ± 6.66 kg, 163.65 ± 5.58 cm) and 60 males (31.22 ± 6.06 years, 75.67 ± 9.81 kg, 177.10 ± 6.16 cm), with a functional equinus condition walked onto a pressure platform. In two separate testing sessions, five trials of each foot were conducted for the first, second, and third steps. We measured the contact surface areas for each of the three phases of the stance phase. We computed the intraclass correlation coefficient and standard error of the mean to assess the reliability. We found significantly greater contact surface areas in males than females in the first, second, and third steps in all phases of the stance phase: heel strike, mid-stance, and take-off. This is important information for the design of footwear and orthotics and gender knowledge. In a functional equinus condition, males have registered greater contact surface areas than females in all phases of the dynamic footprint of the stance phase.

Customized foot insoles (CFI) have been recognized to reduce the prevalence of foot disorders in sport. The aim of this study was to evaluate the effect of four types of CFI on the activity patterns of the lower limb muscles (LLM) in healthy people during sport motorcycling. Methods: This was a cross-over trial (NCT03734133. Participants were recruited from an outpatient foot specialist clinic. Their mean age was 33 ± 5.14 years. While participants were sport motorcycling in a simulator, the electromyography (EMG) function was registered for LLM via surface electrodes. Participants completed separate tests while wearing one of four types of CFI: (1) only polypropylene (58° Shore D), (2) selective aluminum (60 HB Brinell hardness) in metatarsal and first hallux areas and polypropylene elsewhere (58° Shore D), (3) ethylene vinyl acetate (EVA) (52° Shore A), and (4) standard EVA (25° Shore A) as the control. Results: The activity patterns of the LLM while sport motorcycling showed significantly lower peak amplitude for the selective aluminum CFI than the other types of CFI. Conclusion: EMG amplitude peaks for several LLM were smaller for the hardest CFI (selective aluminum 60 HB Brinell hardness) than the other CFIs (polypropylene 58° Shore D, EVA 52° Shore A, and standard EVA 25° Shore A), except for the fibularis longus in right curves that is increased when the knee touches the road increasing the stability.

Purpose: The goal of the present study was to assess, by ultrasound imaging (USI), the thickness of the plantar fascia (PF) at the insertion of the calcaneus, mid and forefoot fascial locations, and the calcaneal fat pad (CFP) in patients with Achilles tendinopathy (AT). Methods: An observational case-control study. A total sample of 143 individuals from 18 to 55 years was evaluated by USI in the study. The sample was divided into two groups: A group composed of the chronic non-insertional AT (n = 71) and B group comprised by healthy subjects (n = 72). The PF thicknesses at insertion on the calcaneus, midfoot, rearfoot and CFP were evaluated by USI. Results: the CFP and PF at the calcaneus thickness showed statistically significant differences (P < 0.01) with a decrease for the tendinopathy group with respect to the control group. For the PF midfoot and forefoot thickness, no significant differences (P > 0.05) were observed between groups. Conclusion: The thickness of the PF at the insertion and the CPF is reduced in patients with AT measured by USI.

Background: Asthma may be considered as a non-communicable condition associated with higher bronchial responsiveness that may impair quality of life (QoL). Purpose: The research aim was to compare scores of depression, as well as general and foot health-related QoL, in patients who suffered from asthma with respect to healthy subjects. Methods: A total sample of 152 subjects, median age of 37.00 ± 16.00 years, were recruited from a respiratory and allergy department of a hospital and divided into patients with asthma (n = 76) and healthy subjects (n = 76). The scores of the Spanish foot health status questionnaire (SFHSQ) domains as well as the Spanish Beck’s Depression Inventory (BDI) scores and categories were collected. Results: The only statistically significant difference (p < 0.05) was shown for the difference of the FHSQ footwear domain establishing that patients who suffered from asthma presented a worse QoL related to foot health for footwear (lower FHSQ scores) compared to healthy matched-paired participants (higher FHSQ scores). Regarding the rest of the outcome measurements, there were no statistically significant differences (p > 0.05) for the other FHSQ domains scores as well as the BDI scores and categories. Conclusions: Patients with allergic asthma presented impairment of the QoL related to foot health for footwear, which seemed to be linked to the presence of asthma.

ABSTRACT BACKGROUND: Intellectual disabilities (IDs) usually derive from neurodevelopmental disabilities. They limit intellectual functioning and cause adaptive behaviors and orthopedic problems. These disabilities have harmful effects on health, everyday practical skills and social functioning, and they diminish quality of life. The goal of our research was to perform podiatric evaluations on schoolchildren with and without ID and ascertain their records of foot disorders. DESIGN AND SETTING: Analytical cross-sectional study conducted at a podiatric clinic in the city of Piedras Blancas, province of Asturias, Spain. METHODS: An analytical cross-sectional study on 82 schoolchildren affected by ID, compared with 117 healthy schoolchildren, was conducted at a podiatric clinic. Demographic data, clinical characteristics and measurements relating to podiatric examinations were recorded among the participants who completed all phases of the tool that was used in the study process. RESULTS: Almost 90% of the schoolchildren with and without ID presented foot disorders relating to smaller toes, nail disorders, flat feet or lower-limb alterations. CONCLUSIONS: The participants showed elevated prevalence of foot disorders. Podiatric evaluations are a significant means for preventing the appearance of medical conditions and/or foot problems, and they also improve general health.