Aims: The aims of this programme of research are to investigate the subjective description of ischaemic pain and to investigate the effects of TENS on lower limb ischaemic pain and walking performance in patients with Intermittent Claudication (IC). Methods: Four studies were conducted: two in the laboratory and two clinical trials. Laboratory- The first study investigated the reliability of a method of inducing lower limb ischaemic pain in healthy volunteers, the modified Submaximal Effort Tourniquet Test (mSETT). The second investigated the effects of High Frequency TENS (HF-TENS) and Placebo TENS (P-TENS) on lower limb ischaemic pain induced using the mSETT in healthy volunteers. Clinical- The first clinical study investigated the effects of HF-TENS and Low Frequency TENS (LF-TENS) on measures of pain and treadmill walking performance in patients with Peripheral Arterial Disease (PAD) and IC. The second examined patients’ experiences of using TENS at home for PAD and IC. Results: The mSETT was found to have good test-retest reliability and induce pain similar in quality to that experienced by patients with IC. The pain experience induced with the mSETT was reduced by both HF- and P-TENS compared to baseline. HF-TENS however was more effective compared to P-TENS in this regard, prolonging time to pain threshold and tolerance whilst reducing the levels of pain reported throughout. In patients with PAD and IC, HF and LF-TENS interventions were found to increase maximum walking distance on a treadmill compared to P-TENS. HF-TENS was also found to increase pain-free walking distance. The experience of using TENS in daily life was characterised by feelings of both benefit and disappointment. This was interpreted through the following themes: (i) ‘masking, but not taking the pain away’ and (ii) ‘walking further, but not far enough’. Conclusions: The mSETT is a reliable method of inducing lower limb, ischaemic pain in healthy volunteers and could be useful for the purposes of pre-clinical analgesic trials and investigation of the ischaemic pain experience. HF-TENS was found to reduce mSETT pain indicating hypoalgesic effects of TENS in experimentally induced, lower limb ischaemic pain. HF and LF-TENS have potential as interventions that increase walking performance for patients with IC. If using TENS at home for IC, expectations of treatment effect need to be managed to avoid disappointment and feelings of frustration.

Hallux rigidus (HR) is the second most common pathology affecting the first metatarsophalangeal joint and a primary cause of morbidity and disability. Classification of this condition helps to inform management. Over the years a number of formal HR classification systems have been devised but despite this collective experience there is no consensus on classification design, construction, application or parameters’ validity. The aim of this research was to develop an evidence-based classification framework for HR and establish its validation and reproducibility. This was achieved through four studies. An initial study of 110 patients was used to determine the clinical parameters of HR. In addition to other pertinent findings this showed a positive relationship between second toe length and first metatarsophalangeal joint pain (P<0.001). Correlations were found between first metatarsophalangeal joint pain and pes planus (r=0.84, P=0.05) and between reduced first metatarsophalangeal joint range of motion and hallux abductus interphalangeus (r=0.92, P=0.05). A second study examined the radiological parameters of HR (in the same population). Amongst other relevant findings comparison of joint space narrowing with either hallux abductus interphalangeus (P<0.005) or osteophyte severity (P<0.002) was established. Intra and inter-rater reliability studies were undertaken for all parameters. Overall, inter-rater reliability was poor. Only 28% of angular inter-rater measurements fell within a 5° range. A fourth study was used to determine ‘expert’ opinion on HR classification using semi-structured interviews. The results revealed the need for consensus agreement among clinicians and patient involvement in creation and substantiation of classification content. This research has provided a new understanding of HR classification and informed the development of a HR classification framework based on history, clinical and radiological domains. The established framework provides more than just a measure of severity and includes other dimensions such as contributory factors and functionality. Depending on its context, other applications include use as a diagnostic tool, establishing HR prevalence, monitoring progress, and surgical decision making. An algorithmic approach can enable the classification framework to be applied in different contexts proving clinical relevance and meaning to a range of professions. This research also highlights that classification parameters should be validated, reliable, sensitive, quantifiable and few in numbers and that there is a requirement to provide a ‘gold standard’ against which future HR research can be compared.

No description available.

M.Tech. / The positioning of the Podiatry profession in South Africa is potentially compromised in that the profession has been excluded from the National Health System (NHS). This exclusion has led to queries concerning the role and position of Podiatry within the South African health care structures. The fact that the Scopes of Practice for Podiatrists have not been reviewed since 1982, implies that they may not have kept abreast with the changes taking place in a democratic society, and might have been viewed as irrelevant to the new government's health priorities, and therefore caused the legislators to overlook the Podiatry profession, or alternatively, there may have been other reasons not yet apparent. The aim of this study was to determine the position of the Podiatry profession within the NHS. The specific objectives were: • To review the literature and health policy documents regarding the position of the Podiatry profession within the South African health structures; • To determine the basis for the exclusion ofthe Podiatry profession from the NHS; • To develop an up-to-date Scope of Practice that meets the requirements of the Podiatry profession and the current national health care priorities; • To make recommendations to the Professional Board for Physiotherapy, Podiatry and Biokinetics concerning the content of a revised Scope of Practice; and • To make recommendations to the Department of Health (DoH) regarding the positioning of Podiatry within the NHS. This qualitative study involved structured interviews, a questionnaire and the use of focus groups. Some of the conclusions made are the following: • The DoH has excluded Podiatry from the list of primary health care service providers. However, for the Podiatry profession to be positioned within the NHS, the profession has to indicate to the DoH the role they would like to play within the NHS.

Footwear is manufactured from foot forms or moulds known as “lasts”, based on certain measurements of the feet for whom the footwear is intended. Measurement or morphometric studies of the foot in other populations reveal differences due to genetic, ethnic and/or racial differences. Most last measurements used in the South African (SA) footwear industry are based on the British (UK) standard and assume an average fit for the entire population. No three dimensional (3-D) measurement data existed on the SA female foot that was statistically representative of all major ethnic groups of the female population. This was needed to test the current applicability of the UK standard, in light of previous findings that 80% of a random sample of South African women reported foot pathology ascribed to ill-fitting footwear. Further, this would address a suggestion that foot measurements might be non-linear in grading between small size individuals (size 3, 4 and 5) and large size individuals (size 8, 9 and 10). This study essentially consists of three parts. First, a preliminary study undertook to find or create a suitable and affordable method of 3-D input, not only to obtain morphometric measurements but also to capture the topography of the weight bearing foot for future research and development of contoured foot beds for industry. Second, a comparison of specific measurements from a UK size 4 last and the corresponding foot measurements from a sampled population of size 4 foot length was performed, in order to determine what percentage of women would fit the footwear derived from such a last. Third, a comparison of mean values was carried out between data from participants of all sizes scaled down arithmetically to UK size 4 length, and data from actual size 4 participants, in order to explore whether the size 4, occurring as it does near the lower end of the size range, could still be representative of the proportional measurements for sizes 3 to 10. The mean values of this second scaled size 4 group were also compared to the UK size 4 last measurements. The first part of the study utilized the resources of collaborative partners to locate 3-D hardware and software. Experimentation with compounds isolated a suitable impression material and platform designs were conceived to facilitate the data capture method developed. The invented method was awarded patent rights. The second part of the study used the method developed from the preliminary study to conduct measurements. 3-D Laser scanning in combination with manual measurement for validation, by convenience sampling of each of 510 active women aged 21 to 69, of differing ethnic origins, in two major urban regions, yielded 13 foot measurements of each participant. Last measurements were captured by means of comparable laser scanning of a UK size 4 last. In the second part of the study, eight of the comparable measurements for size 4 feet and the last were compared for accuracy of fit. The third part of the study compared mean values between data from non size 4 participants scaled down arithmetically to UK size 4 length, and data from actual size 4 participants. Part one of the study successfully developed and patented a new, portable, low-cost method which can be used to measure either a last or foot in 3-D for any footwear consumer group. Results of the metric study in part two indicate that four dimensions of the industry standard last do not fit the corresponding four dimensions of the average foot measured, namely forefoot girth, forefoot width, heel width and minor foot length (heel to fifth toe). More than 75.6% of participants from every ethnic group displayed tread girths larger than that of the last. These findings have serious implications since deficit fit in any of these four dimensions impacts negatively on foot health and function within the shoe. As such, results could not support the null hypothesis that the shoe fits the foot. Results in the third part of the study yielded similar mean values for measurement parameters between the two groups of data, indicating that the mean measurements for a size 4, even though it is placed near the lower end of the size range, can be representative of the mean scaleable measurements for sizes 3 to 10 but only for the length grade. In conclusion, the study developed and patented a new method for a scientific process to record the weight bearing foot in 3-D. It produced the first national database of 3-D measurements of a female population on the African continent. Outcomes included new prototypes, innovation and technology transfer to industry. The study prompted the development of new footwear by the manufacturing industry partner, utilizing information gained from the study. The study has given impetus to continuing research on the African foot. / Mrs. Saramarie Eagleton Doctor Bernhard Zipfel

Thesis (M.H.S.A.)--University of Michigan, 1979. / "Questionnaire results" and additional matter laid in.

Thesis (M.H.S.A.)--University of Michigan, 1979. / "Questionnaire results" and additional matter laid in.

Sever's disease, or Calcaneal Apophysitis, is a common condition affecting children. It has been examined at a review level at best since first being described in 1907. The aim of this study was to compare the characteristics of a group of children with Sever's disease with a non-symptomatic group of children of similar age. This prospective study had two main objectives. Firstly, to examine issues which had been anecdotally raised in the literature over the years; secondly, to determine the quality of life effects on children with Sever's disease. / A literature review of Sever's disease articles was undertaken to identify what was known, and what was surmised about the disease. The literature was also reviewed to allow selection of the correct tools to determine if there were any differences between the two groups of children. Issues such as reliability and validity as well as suitability of questionnaires were examined and justified from the literature. / Several areas arose which the literature did not adequately cover, including the reliability of foot measures, validity of a new measure - the Foot Posture Index, and a reliable and valid way to measure the dorsiflexion of the foot on the leg. Experiment 1 established that the intra rater reliability of the measurements to be used in Experiment 4 was good, but that the inter rater reliability was poor to moderate. Experiment 2 investigated the criterion validity of four components of the foot Posture Index, a new measurement that was to be used in Experiment 4, concluding that gross movements could be shown, but not subtle foot position changes. Experiment 3 developed equipment for the measurement of ankle joint dorsiflexion, another parameter to be measured in Experiment 4, and established that the intra and inter rater reliability of this apparatus was excellent. / Experiment 4 involved the gathering of data relating to Body Mass Index, activity, foot posture, traditional foot measures, ankle joint dorsiflexion and quality of life from the two aforementioned groups. Binary logistic regression was used to determine the odds ratios of various factors for the Sever's disease and non-Sever's disease group. The only significant differences between the groups were in quality of life scales and in forefoot to rearfoot determination. The implications of these findings are discussed. / Thesis (PhD)--University of South Australia, 2006.

No description available.

Plantar skin callus plaques are a common, frequently painful hyperkeratotic condition affecting a number of the population and these hard, dense, yellowish, cutaneous lesions may even be sufficiently severe to limit working practices and social activities. Pathological callus formation is thought, empirically from clinical observation, to be due to excess intermittent pressure during gait, associated frequently with a structural or functional anomaly of the foot and leg. Studies into callus pathology are relatively few and have been concerned mainly with the structure and ultrastructure of callus tissue. The biomechanical features of plantar skin callus have been studied and results show it behaves differently from normal plantar and hairy skin. The current work extends the understanding of plantar skin calluses, their aetiology and pathology, utilising techniques, with some novel applications, from a number of fields. The mechanical forces exerted on the callused foot at the time of lesion loading were studied using the Kistler force and Musgrave pressure measurement plates. The duration of loading of the lesion was found to be increased compared with that of a normally functioning foot (p = 0.05). It was not possible to attribute reactive forces exerted on the foot at the time of loading to the lesion site, as appropriate technological advances have yet to be made. No predominant force vector was found which could be associated with the clinical appearance of plantar callus plaques. The clinical appearance of the callus lesion cannot therefore be used as an indicator of influential mechanical stresses. There is no relationship between either the dominant side and callus incidence on left or right feet or the different skin ridging patterns (dermatoglyphics) of callus lesions and their viscoelasticity. However, the results from rheological studies of this tissue suggested that the viscoelastic properties of areas of the stratum corneum within the callus plaque may be influential in the formation of the dermatoglyphic patterns found in these lesions. Fourier Transform Infrared Spectrometry was used to provide fundamental information for the rheological studies on plantar skin callus tissue and also confirmed the clinical assumption that callus tissue had a lower water content than normal plantar skin. A-scan ultrasound skin imaging (Dermal Depth Detector) with which it was hoped to quantify the topographical features of the lesion was not successful, probably due to the limitations of the instrument and transducer in this application, rather than the technique in general. Light microscopical examination of plantar callus sections was in general agreement with previous studies. The most notable feature was the disruption or absence of the granular layer in callus and corns respectively. A model for callus formation has been proposed partly as a result of the information generated during the course of study. An accelerated transit rate of callus keratinocytes is likely to result in cell immaturity on reaching the stratum corneum since differentiation will not have had time to be completed. Thus a number of differences in plantar callus will be evident, such as altered cell cohesion and desquammation. The results of this work will provide useful data which may direct further studies into suitable therapeutic modalities, thus extending the range of methods available for treatment of this common condition.