Use of appropriate footwear among diabetics and those with diabetic foot problems has been well documented to play a vital role in the prevention and treatment of established foot disease. The incidence and prevalence rates of diabetes in Africa are increasing and foot complications are rising parallel. Nigeria is Africa’s most populous nation which also has the highest number of people (up to 3 million) suffering with diabetes in the continent. This is related to the lifestyle of the people which is changing including diet. Many urbanites are embracing Western way of living. There is however lack of adequate knowledge about the role of footwear in the management of foot related problems among diabetic patients in the country. This study is the first of its kind to be done in Nigeria with an aim to develop a framework that would help to identify appropriate footwear materials and designs for people suffering with diabetes. To achieve this, data were collected through questionnaire and interview surveys, shoe upper materials analysis and foot measurements. In addition, Product Design Specification (PDS) and design framework were formulated. And functional footwear prototypes were designed, constructed and assessed. The data from the questionnaire survey indicate that up to 75% of the diabetic subjects have not received information about the type of footwear they should wear most often. The study revealed that the patients have very poor knowledge about diabetes and its complications, foot care, and the use of appropriate footwear. It was discovered that up to 53% female and 37% male of the patients were wearing slippers most often. Similarly, the findings from the medical doctors interviewed show that up to 66% of the patients were wearing slippers or slip-on (with no fastening mechanism) most often. The research revealed that financial constraint was a key factor to use of appropriate footwear by the patients. Many use cheap footwear regardless whether they provide the required protection and comfort to their feet or not. It was found out that specialist knowledge among medical doctors regarding foot care and provision of special footwear like orthopaedic and diabetic footwear to patients was very low. The shoe upper materials analyses demonstrated that leather has good physical properties required for making diabetic footwear. Data from the measurement of feet indicated that no individual’s feet are exactly the same even as people wearing the same shoe size might not have the same foot dimensions. It was concluded that these differences could have considerable effects on the shoe wearer. From the measured values, the tolerable allowance was found to be 3.4mm and 3.5mm for male and female subjects respectively. The fitting and comfort assessment of the prototypes have shown that some parts of the last used to make the prototypes would require amendments in order to accommodate minor foot deformities properly. The findings from the research were used to develop PDS and a research framework which could be used as a guide for diabetic footwear design and construction. Finally, the contributions of this research to knowledge and critical areas that would require further investigations were outlined.

A dissertation presented in partial fulfilment of the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Low -Dye taping is a method commonly used in sport participation and normal daily activity (Harradine, Herrington and Wright, 2001). It has been indicated in support of injured structures, decreasing edema and protection against re-injury (Reid, 1992:232). Contrary to these beliefs, studies have shown that low -dye anti-pronatory control is lost after relatively short episodes of exercise (Ator et al., 1991 and Vicenzino et aL, 1997). The variations in dynamic foot function with low -dye taping is not well understood, although tapin.g of the foot in low-dye type method has been advocated by many authors (Brantingham et aL, 1992, Ryan, 1995 and Chandler and Kibler, 1993). It was the purpose of this study to investigate the maximum ground reaction force and percentage contact time within 10 demarcated regions of the foot in asymptomatic patient with pes planus, cavus and normal medial longitudinal arches at four time intervals over 24 hours. Having established its baseline function it may serve as point of reference for clinical trials that wish to determine the role of taping as part of the management of symptomatic feet. This trial consisted of 60 participants with asymptomatic feet that were divided into three groups of 20. Participants were divided into three groups depending on their respective foot structures. To qualify for one of the three groups subjects had to either have flexible low, high or normal medial longitudinal arches. Maximum ground reaction forces (GRF) and Percent contact time was obtained for each of the three groups and for each of four visits. GRF were obtained with the aid of a registered orthotist who has agreed to work with the researcher on this project using the RSscan International 1m footscan plate system (Appendix L). The data was interpreted and analyzed using the RSscan Clinical Version 7.08 software package. / M

The purpose of this study was to examine the effects of different surfaces on lower limb motion and encountered pressures at two locations on the plantar surface of the right foot. Nine females performed five trials for each of four surface conditions. The results provided no evidence for surface-related changes in experienced foot contact pressures. Both asphalt and grass surfaces resulted in the shortest relative time of forefoot immobility. No surface related differences were found for the range of pronation.

The goal of the work presented herein was to further our understanding of Bovine Leukocyte Antigen (BoLA) class I diversity of Holstein cattle and develop tools to measure class I restricted T cell responses to intracellular pathogens such as foot and mouth disease virus (FMDV) following vaccination. BoLA is a highly polymorphic gene region that allows the bovine immune system to differentiate pathogen-infected cells from healthy cells. Immune surveillance by CD8+ T cells plays an important role in clearing viral infections. These CD8+ T cells recognize BoLA class I molecules bearing epitopes (antigenic peptides) of intracellular origin in their peptide binding groove. Polymorphisms in the peptide binding region of class I molecules determine affinity of peptide binding and stability during antigen presentation. Different antigen peptide motifs are associated with specific genetic sequences of class I molecules. In order to better understand the adaptive immune response mediated by BoLA molecules, technologies from human medicine such as high-throughput sequencing, biochemical affinity and stability assays, tetramers and IFN-γ ELIspot assays could be applied. Therefore, it was hypothesized that we can translate these technologies from the study of human T cell responses to the study of cattle immunity. The first objective was to establish a comprehensive method for genotyping BoLA of Holstein cattle by using Illumina MiSeq, Sanger sequencing and polymerase chain reaction sequence-specific primers (PCR-SSP) (See Chapter 2). This is an important first step in order to study the BoLA restricted immune responses following FMDV vaccination. The second objective was to define the FMDV capsid protein peptide repertoire bound by BoLA class I molecules using bioinformatics and biochemical affinity and stability assays to facilitate the identification of T cell epitopes (See Chapter 3). The third objective was to demonstrate clonal T cell expansion for specific epitope polypeptides using ex-vivo multi-color flow cytometric MHC-epitope complexes (tetramers), followed by IFN-γ production measured by an ELIspot assay to quantify and define the antigen specific response of Holstein cattle to FMDV vaccination (see Chapter 4). In this, my dissertation studies aimed to improve our understanding of the BoLA class I restricted T-cell responses to candidate FMDV vaccines in Holstein cattle. In this manner, my research will improve animal health through the production of assays for characterizing the bovine immune response to intracellular pathogens and enhance vaccine design leading to improved biologicals to protect cattle from devastating infectious diseases.

Title of diploma thesis: Specific foot changes in figure skaters and options for their physiotherapeutic intervention. Objective: The purpose of this thesis is to research available literary sources concerning anatomy, kinesiology and biomechanics of foot and foot arch in relation to specific foot changes resulting from figure skating. In addition, the thesis seeks to research various physiotherapeutic approaches which could be applied in prevention, compesation or therapy of these changes. Methods: This diploma thesis has descriptively-analytical character. It is structured in the form of literary research. Results: On the basis of the researched literary sources, this thesis provides a comprehensive picture on the topic of foot in figure skaters. Based on the research, the thesis identifies foot changes resulting from deformation of the foot in the skate. Subsequently, the thesis discussess the possible physiotherapeutic approaches which can be applied in prevention, compensation or therapy of these changes. Key words: foot, figure skating, flatfoot, physiotherapy

L’ostéite du pied diabétique (OPD) est une complication survenant à la suite d’une plaie située sous les malléoles chez un patient diabétique. L’OPD survient à la faveur d’une plaie généralement chronique du pied favorisée par la neuropathie e/ou l’artérite des membres inférieurs fréquemment associées au diabète. Il s’agit bien d’une ostéite et non d’une ostéomyélite car l’origine hématogène de l’OPD n’est pratiquement pas décrite. L’OPD est une affection dont l’incidence augmente régulièrement avec l’évolution du diabète dans le monde. On estime en effet que 15 à 25% des patients diabétiques présenteront à un quelconque moment de leur existence une ulcération du pied qui subira une infection dans 40 à 80% des cas. L’OPD retarde la cicatrisation des plaies qui ont conduit à sa survenue et augmente significativement le risque d’amputation mineure ou majeure. C’est, avec l’artérite des membres inférieurs, l’une des grandes causes d’amputation d’un membre inférieur chez les patients diabétiques. L’OPD est avant tout une infection ostéo-articulaire qui survient sur un terrain particulier. L’altération des défenses immunitaires systémiques et locales, quoique variables d’un sujet diabétique à un autre, réduit les chances de guérison de l’OPD. S’agissant d’une infection ostéo-articulaire chronique le plus souvent staphylococcique survenant sur un terrain fragilisé il a longtemps été estimée que la guérison ne pouvait être espérée sans la suppression du tissu ostéo-articulaire infecté, en pratique sans amputation. L’amputation n’est cependant pas sans conséquence fonctionnelle et » l’épargne ostéo-articulaire » a été prônée ces dernières années sous deux formes : la résection ostéo-articulaire suspendue ou « amputation fonctionnelle » et le traitement purement médical faisant appel principalement aux antibiotiques. Le traitement médical de l’OPD a l’avantage de n’entraîner aucune lésion anatomique du pied. Il a l’inconvénient de faire appel à des molécules antibiotiques réputées efficaces dans le contexte particulier d’infection ostéo-articulaire chronique qui ont pour la plupart des molécules un effet de pression de sélection de la résistance bactérienne élevé et pour la plupart un potentiel toxique majoré par les co-morbidités fréquemment observées chez ces patients. En considérant les règles généralement admises pour le traitement des infections ostéo-articulaires, il apparait que le choix des antibiotiques doit idéalement être fondé sur les données de la culture d'un fragment osseux. Ceci représente cependant une approche nouvelle pour le traitement antibiotique de l'OPD. Nous montrerons dans ce travail les résultats de travaux publiés suggérant que:1) la biopsie osseuse transcutanée est une technique dénué de risque et actuellement la seule technique permettant une documentation fiable de l’OPD et que les prélèvements obtenus par écouvillonnage ou par ponction-aspiration ne peuvent être utilisés en remplacement de la biopsie osseuse (articles 1 et 2)2) les patients traités médicalement pour OPD ont plus de chance de guérir lorsque le traitement est fondé sur les résultats d'une biopsie osseuse (article 3) nque sur ceux de prélèvements superficiels3) la biopsie osseuse transcutanée n'est actuellement pratiquement pas utilisée dans la majorité des centres Français du pied diabétique. Enfin, nous présenterons les projets de 3 études sur le sujet de la biopsie osseuse en cours ou qui seront développées dans les mois à venir. / Diabetic foot osteomyelitis (DFO) is a complication of a foot wound located under malleoli. DFO usually occurs as a consequence of a chronic foot wound and is facilitated by neuropathy and peripheral vascular disease (PVD) which are both frequently associated with diabetes. OPD is rather an osteitis than an osteomyelitis as a hematogenous origin of DFO is almost not reported. DFO is an increasing worldwide problem which is related to the increasing number of patients with diabetes in the world. It is generally admitted that 15 to 25% of all patients with diabetes will experience a foot wound during their lifetime and that 40 to 80% of them will be infected. DFO has a deleterious effect on the wound healing and is associated with an enhanced risk for relapsing infection of the foot. DFO is with PVD a major cause for both minor and major limb amputations in these patients. DFO is first of all a bone and joint infection that occurs in a patient with diabetes. Complications of advanced diabetes mellitus like microvascular abnormalities and phagocytosis defects are likely to reduce the chance of healing. As most DFO are due to Staphylococcus aureus and that most of these patients have comorbidities, it has generally been thought that bone removal was required in order to obtain a complete healing. Minor amputation may however result in biomechanic disorders of the foot and subsequently may lead to new episodes of foot wound thus new DFO episodes. As a consequence, some authors have proposed to perform limited bone resections (i.e. without ray or toe amputation) or to use a medical approach of DFO (i.e. based on antibiotic therapy only). Medical treatment of DFO has the advantage to avoid the development of biomechanic alterations of the foot. However, given the high potential for selecting bacterial resistance of antimicrobial agents like rifampin and fluoroquinolones, it appears that the choice of the antibiotics to use should be best based on the microbiological testing of a bone culture which is consistent with the basic rules widely admitted for the medical treatment of any other bone and joint infections. This represents, nevertheless, a new approach of the treatment medical treatment of DFO. We will present in the present document the results of personal studies that suggest that 1) bone biopsy is a safe procedure and is currently the best method for obtained a reliable microbiological documentation of DFO and, in particular, that both swabs and needle aspiration cannot be used a surrogate tools for determining the pathogens involved in DFO (articles 1 and 2). 2) patients with DFO treated medically have a better chance to heal when the antibiotic therapy is guided by the results of a bone biopsy than when it is guided by superficial sample results (-article 3)3) bone biopsy is not used routinely used in most French diabetic foot centers (article 4). Finally, we will present 3 projects of study that are currently on process or will be developed in the next future.

Master of Science / Department of Agricultural Economics / Ted C. Schroeder / The livestock industry is susceptible to several diseases, of which Foot and Mouth Disease (FMD) is one. FMD is neither a fatal nor zoonotic animal disease, but most animals less than one year of age are killed in about 80% of cases. FMD also causes reductions in yield and milk production. FMD is recognized as an economic disease because any outbreak will lead to a drastic reduction in the export market. This study is centered on livestock production in mid-western United States. The study incorporated the result from an epidemiology model into an equilibrium displacement model; this is used to determine the economic impact of the FMD outbreak on both consumers and producers. Three vaccination-to-die scenarios were simulated. Each scenario had 200 disease spread simulation runs. The economic impact results were presented with normal distribution curves in order to see how the economic impacts were distributed across the 200 runs in each scenario. Scenario 14 with 50 and 80 herds vaccination capacity at 22 and 40 days respectively, coupled with 50 km vaccination zone has the lowest negative impact on both consumer and producers. The diseases lasted for shorter period of time in scenario 14 than scenarios 2 and 12. Scenario 14 also has least number of animals killed. It can be concluded from the equilibrium displacement outcomes that the best mitigation strategy for the control of FMD is to have a large vaccination zone area, and increment in the vaccination capacity will also curb the disease on time.

O objetivo deste estudo foi adaptar e validar o Foot Health Status Questionnaire (FHSQ) avaliando suas propriedades de medida. Este instrumento foi traduzido, traduzido de volta para o inglês, avaliado por comitê multidisciplinar e submetido a pré-teste, gerando o FHSQ-Br. O FHSQ-Br foi submetido a teste de campo em um grupo de estudo composto por 65 pacientes com Artrite Reumatóide (AR) para avaliar a confiabilidade teste-reteste, a consistência interna e a validade do construto. A validade do construto foi testada correlacionando os escores do instrumento com dados clínicos e laboratoriais usados para avaliar a AR. Este estudo demonstrou que o FHSQ-Br é um instrumento confiável, consistente e válido, útil na avaliação da saúde dos pés, sendo passível de adaptação para diferentes culturas / The purpose of this study was to conduct a cross-cultural adaptation and validation of the Foot Health Status Questionnaire (FHSQ) evaluating its measurement properties. All ten domains of the FHSQ were translated into Portuguese by two Brazilian translators creating Version 1. This version was back-translated by two native English-speaking teachers who made suggestions for Version 1, creating Version 2. A multidisciplinary committee was formed to test the instrument’s semantic, idiomatic, experiential and conceptual equivalences. After being reformulated and approved by the committee, Version 3 was pre-tested on a group of patients from the Rheumatology Service of the Hospital das Clínicas. They answered this version and made suggestions for the better understanding of the instructions, questions and response option. The FHSQ-Br was then created. The translated and adapted version was submitted to field test on a study group composed of sixty-five Rheumatoid Arthritis (RA) patients to evaluate test-retest reliability, internal consistency and construct validity. The construct validity of the FHSQ-Br was tested correlating the scores to clinical and laboratory parameters commonly used to assess RA (Health Assessment Questionnaire; Numbered Rating Scale for foot pain; foot X-rays; erythrocyte sedimentation rate and C-reactive protein). The cultural adaptation of the FHSQ was successfully accomplished, since patients suggested changes in only three items of the instrument during the pre-test phase. In the field test, the intra-class correlation coefficients showed high reliability for both intra- and inter-observer correlations. Internal consistency coefficients were statistically significant (p<0.05) for all domains. As for the evaluation of the construct validity, each domain revealed correlations with a specific group of parameters, according to what the domains were intended to measure. The FHSQ was cross-culturally adapted generating a reliable, consistent and valid instrument. This study has proven the FHSQ-Br to be a useful tool to evaluate foot health in systemic diseases and is easily adaptable to different cultures

Estudo descritivo cujo objetivo foi traçar o perfil dos pacientes com diabetes mellitus (DM) que possuem úlcera no pé, atendidos no Ambulatório de Especialidades Mario Covas de Marília-SP. A amostra foi constituída por 60 pacientes atendidos no período de agosto a setembro de 2003. Para coleta de dados utilizou-se entrevista, consulta ao prontuário e avaliação dos pés. Os resultados mostraram maior freqüência no sexo masculino (51,7%), destacando a faixa etária de 50 a 70 anos (64,4%). Em relação ao tipo de diabetes, 95% eram do tipo 2; o tempo médio referido do diagnóstico foi de 12,6 anos e do tratamento 12,1 anos; 63% referiram realizar dieta, 56,7% faziam uso de antidiabético oral e 61,7% de insulina. Considerando os parâmetros de controle do diabetes, 79,6% apresentavam mau controle glicêmico e 56,6% sobrepeso. As complicações crônicas mais freqüentes foram retinopatia (31,7%) e pé diabético associado à doença vascular periférica ( 31,7%). Todos apresentavam hipertensão arterial e em 26,6% estava associada à obstrução arterial crônica. O diagnóstico de obstrução arterial crônica estava presente em 51,7% dos pacientes. Na avaliação dos pés, 53,3% deambulavam; 55% possuíam alteração na marcha; 55% amputação prévia; 48% história de úlceras anteriores; 65% corte de unhas inadequado; 31,7% dedos em garra; 23,3% dedos sobrepostos; 18,3% proeminência do primeiro metatarso; 45% usavam sapatos e meias inadequados. Na avaliação circulatória identificou-se entre os pacientes, pulsos não palpáveis em 27% do tibial posterior direito e 23% do esquerdo; em 26% do pedioso direito e 21% do esquerdo; 35% possuíam edema; 45% rubor na pendência e empalidecimento à elevação; a sensibilidade tátil pressórica estava ausente em 38,3% dos pacientes. Quanto as características das úlceras, 36,6% relataram como causa de maior freqüência bolha infectada e 26,6% trauma mecânico; a localização mais freqüente foi na região plantar (23,3%) e nos dedos (21,7%); o tempo médio das úlceras foi de 0,9 anos; dimensões de 1 a 10 cm2 (65%); 41,7% das úlceras possuíam leito de cor vermelha; 53,3% exsudato4 seroso; 38,3% dor moderada; 58,3% odor discreto e 46,7% grau 2 segundo a classificação de Wagner. O tratamento mais referido para as úlceras foi soro fisiológico e óleo de girassol (81,7% ).Os resultados deste estudo mostraram a gravidade das complicações relacionadas aos pés dos pacientes com diabetes, destacando a história de úlcera e amputação anterior, complicações vasculares e neuropatia como importante fatores de risco para as lesões em pés e trauma extrínseco como principal desencadeante destas lesões, reiterando que intervenções básicas podem contribuir para a sua redução. Apontaram também para a necessidade de elaboração de um protocolo de atendimento; com ênfase no processo educativo junto a pessoa, familiares e profissionais, visando uma maior adesão ao tratamento e controle do DM bem como intensificando medidas preventivas no cuidado aos pés. / This descriptive study aimed to establish the profile of diabetes mellitus (DM) patients with foot ulcers, attended at the Ambulatório de Especialidades Mario Covas in Marília-SP, Brazil. The sample consisted of 60 patients, attended in August and September 2003. Data were collected by means of interviews, patient files and foot evaluation. Research results disclosed higher frequency among men (51.7%), especially in the age range from 50 to 70 years (64.4%). 95% of the patients suffered from type 2 diabetes; average reported diagnosis time was 12.6 years and average reported treatment time 12.1 years. 63.3% mentioned a diet, 56.7% took oral antidiabetic drugs and 61.7% took insuline. In view of diabetes control parameters, 79.6% of the patients demonstrated bad glycemic control and 56.6% were overweight. The most frequent chronic complications were retinopathy (31.7%) and diabetic foot associated with peripheric vascular disease (31.7%). All patients demonstrated arterial hypertension, associated with chronic arterial obstruction in 26.6% of the cases. The chronic arterial obstruction diagnosis applied to 51.7% of the patients. With respect to foot evaluation, 53.3% of all patients displayed instability; 55% claudication; 55% previous amputation; 48% ulcer antecedents; 65% inappropriate nail cutting; 31.7% claw toes; 23.3% hammer toes; 18.3% prominence of the metatarsus and 45% used inadequate shoes and socks. During circulatory evaluation, pulse could not be palpated in 27% of the right posterior tibial and 23% of the left one; in 26.6% of the right pedal and 21% of the left one; 35% of the patients had edema; 45% dependent redness and blanching on elevation; tactile sensitivity to pressure was absent in 38.3% of the patients. With respect to ulcer characteristics, 36.6% mentioned an infected blister as the most frequent cause and 26.6% a mechanical trauma; the most frequent locations were the plantar (23.3%) and toe (21.7%) region; average ulceration time was 0.9 years, dimensions ranged from 1 to 10 cm2; 41.7% of the ulcers involved redness, 53.3% serous discharge 38.3% moderate pain; 58.3% discrete smell and 46.7% Wagner classification level 2. The most frequently mentioned treatment for ulcers was physiological serum and sunflower oil (81.7%). Study results displayed the seriousness of complications related to diabetic foot, highlighting ulcer antecedents and previous amputation, vascular complications and neuropathy as important risk factors for foot injuries and extrinsic trauma as the main factor leading to this kind of injury, reiterating that basic interventions can contribute to its reduction. Results also indicated the need to elaborate a care protocol, emphasizing the education of patients, family members and professionals with a view to greater treatment adhesion and control of DM, as well as intensifying preventive measures in foot care.

Computer simulation of human foot models can be widely used in areas such as surgery simulation, footwear design, gait analysis, etc. Nevertheless, due to the complexity in the modeling of human foot, not much work in the modeling and simulating of human foot model has been reported. In this thesis, we propose an anatomy-based approach for modeling and animating human foot. The anatomical model is divided into layers including skin, muscle, tendon and skeleton. In order to generate animation of the foot model, foot bone structure is transformed according to the foot motions. This induces the deformation of the muscle, tendon and consequently the skin layer. Physics-based approaches are adopted to deform the muscles and tendons. / In this thesis, we adopt the boundary element method (BEM) with linear boundary elements to model deformation of the muscles. Under our investigation, computing the deformation of models with linear boundary elements of BEM is significantly faster than the BEM with constant boundary elements. It also performs better than the finite element method (FEM) under most circumstances. The role of the tendons on determining deformation of the skin layer is also presented. To allow fast deformation, the axial deformation technique is adopted. Using the axial deformation technique, the shape of the axial curve is adjusted to control the deformation of tendon. Two approaches for updating the axial curve are presented. One approach deforms the axial curve of the tendon using geometric technique based on information from image data. Another approach updates the axial curve based on physical properties of the tendon using the mass-spring system. Each vertex of the skin layer is associated with the underlying muscles, tendons and skeleton. When the underlying muscle, tendon and skeleton layers change their shapes, the skin layer is deformed accordingly. Experimental results illustrated that the visual realism of a foot model is enhanced by considering the changes in foot tendons in the deformation of skin layer. / Tang, Yuk Ming. / "January 2007." / Adviser: Kin-Chuen Hui. / Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5372. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 184-194). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.