Showing papers by "Hylton B. Menz published in 2021"
TL;DR: In adults with mid-portion Achilles tendinopathy, heel lifts were more effective than calf muscle eccentric exercise in reducing pain and improving function at 12 weeks, however, there is uncertainty in the estimate of effect for this outcome and patients may not experience a clinically worthwhile difference between interventions.
Abstract: Objective(s) To compare the efficacy of in-shoe heel lifts to calf muscle eccentric exercise in reducing pain and improving function in mid-portion Achilles tendinopathy. Methods This was a parallel-group randomised superiority trial at a single centre (La Trobe University Health Sciences Clinic, Discipline of Podiatry, Melbourne, Victoria, Australia). One hundred participants (52 women and 48 men, mean age 45.9, SD 9.4 years) with clinically diagnosed and ultrasonographically confirmed mid-portion Achilles tendinopathy were randomly allocated to either a (1) heel lifts (n=50) or (2) eccentric exercise (n=50) group. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 12 weeks. Differences between groups were analysed using intention to treat with analysis of covariance. Results There was 80% follow-up of participants (n=40 per group) at 12 weeks. The mean VISA-A score improved by 26.0 points (95% CI 19.6 to 32.4) in the heel lifts group and by 17.4 points (95% CI 9.5 to 25.3) in the eccentric exercise group. On average, there was a between-group difference in favour of the heel lifts for the VISA-A (adjusted mean difference 9.6, 95% CI 1.8 to 17.4, p=0.016), which approximated, but did not meet our predetermined minimum important difference of 10 points. Conclusion In adults with mid-portion Achilles tendinopathy, heel lifts were more effective than calf muscle eccentric exercise in reducing pain and improving function at 12 weeks. However, there is uncertainty in the estimate of effect for this outcome and patients may not experience a clinically worthwhile difference between interventions. Trial registration number ACTRN12617001225303.
13 citations
TL;DR: In this article, the authors evaluated the efficacy of carbon-fibre shoe-stiffening inserts in individuals with first metatarsophalangeal joint osteoarthritis.
9 citations
TL;DR: It is demonstrated that the temperature sensor provides accurate foot orthosis wear time data and may therefore be a useful tool for documenting adherence in clinical practice and intervention studies.
9 citations
TL;DR: Impact of the SARS-CoV-2 pandemic on the podiatry profession in Australia was likened to a marathon, and not a sprint, with podiatrists describing their “marathon” journey through the pandemic to date.
Abstract: On the 19th of January, 2020, the Chief Medical Officer of Australia issued a statement about a novel coronavirus, or SARS-CoV-2 Since this date, there have been variable jurisdictional responses, including lockdowns, and restrictions on podiatry practice This study aimed to describe impacts of the SARS-CoV-2 pandemic on the podiatry profession in Australia This was a cross sectional study of Australian podiatrists using demographic data collected between 2017 and 2020, and pandemic-related question responses collected between 30th March and 31st August, 2020 Data were collected online and participants described their work settings, patient funding types, business decisions and impacts, and information sources used to guide practice decisions during this time-period Inductive thematic analysis was used to analyse open-ended questions about their practice impact of SARS-CoV-2 There were 732 survey responses, with 465 Australian podiatrists or podiatric surgeons providing responses describing pandemic impact From these responses, 223 (49% of 453) podiatrists reported no supply issues, or having adequate supplies for the foreseeable future with personal protective equipment (PPE) or consumables to support effective infection prevention and control The most frequent responses about employment, or hours of work, impact were reported in the various categories of “business as usual” (n = 312, 67%) Participants described most frequently using the local state and territory Department of Health websites (n = 347, 75%), and the Australian Podiatry Association (n = 334, 72%) to make decisions about their business Overarching themes which resounded through open-ended comments was that working through the pandemic was likened to a marathon, and not a sprint Themes were: (i) commitment to do this, (ii) it’s all in the plan, but not everything goes to plan, (iii) my support team must be part of getting through it, (iv) road blocks happen, and (v) nothing is easy, what’s next? Podiatrists in Australia reported variable pandemic impact on their business decisions, PPE stores, and their valued sources of information Podiatrists also described their “marathon” journey through the pandemic to date, with quotes describing their challenges and highlights Describing these experiences should provide key learnings for future workforce challenges, should further restrictions come into place
9 citations
TL;DR: To determine the feasibility of a clinical trial comparing a podiatry intervention to usual general practitioner (GP) care for people with first metatarsophalangeal (MTP) joint osteoarthritis (OA), a large number of patients are referred to a specialist.
Abstract: OBJECTIVE: To determine the feasibility of a clinical trial comparing a podiatry intervention to usual general practitioner (GP) care for people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). METHODS: A 2-arm, participant- and assessor-blinded, randomized feasibility study was conducted over 12 weeks. Participants were age >40 years and had pain and radiographic OA in the first MTP joint. Participants in the podiatry group had 3 visits and received foot orthoses, exercise, manual therapy, and advice. Participants in the GP group had 1 visit and received medication advice/prescription and the same advice as the podiatry group. Primary outcomes were measures of feasibility (recruitment, attendance, and retention rates; percentage of prescribed exercise sessions completed; orthoses wear hours/day; treatment fidelity). Secondary outcomes included self-reported pain, function, satisfaction, adherence, adverse events, and dropouts. RESULTS: A total of 236 people were screened, and 30 (13%) were included. All except 1 participant in the podiatry group attended the required clinical visits, and retention rates were 93% (podiatry group) and 80% (GP group). Participants completed 66% of the exercise sessions and wore orthoses for an average of 6.3 hours/day. Adherence to medication use was 5.3 on an 11-point numeric rating scale. Both treatment approaches improved pain and function by clinically important differences at 12 weeks. CONCLUSION: A clinical trial comparing a podiatry intervention to usual GP care for people with first MTP joint OA is feasible. Given the improvements in pain and function observed, a larger appropriately powered clinical trial is warranted to evaluate the superiority of one treatment approach over the other.
8 citations
TL;DR: There is a specific and progressive reduction in hallux plantarflexion strength with increasing severity of hallux valgus in older people, which has potential implications for both the aetiology and treatment of this common and disabling condition.
5 citations
TL;DR: In this article, a systematic review and meta-analysis of foot and ankle biomechanics while walking in young and older adults is presented. But the authors did not consider the effect of walking speed on the plantar pressure.
5 citations
TL;DR: In this paper, the authors analysed data from the Bettering the Evaluation and Care of Health program, collected from April 2000 to March 2016, and found that GP referral to podiatrists in Australia increased markedly after the introduction of Medicare funding and appears to be targeted to those with the greatest need.
4 citations
TL;DR: In this paper, the differences in foot dimensions between children with and without Down syndrome were compared using 3D foot scans using three-dimensional (3D) foot scans, and the difference in foot sizes between the two groups was found to be significant.
Abstract: This study compared the differences in foot dimensions between children with and without Down syndrome using three-dimensional (3D) foot scans.51 children with and 51 children without Down syndrome...
4 citations
TL;DR: The feasibility of conducting a definitive randomised trial to evaluate the efficacy of custom-fitted footwear for increasing physical activity in children and adolescents with Down syndrome is feasible.
Abstract: Purpose: To determine the feasibility of conducting a definitive randomised trial to evaluate the efficacy of custom-fitted footwear for increasing physical activity in children and adolescents wit...
4 citations
TL;DR: People with bilateral widespread foot and ankle pain were more likely to be female, obese, depressed, anxious, have/had a manual occupation, have comorbidities, lower SF-12 scores and greater foot-specific disability.
Abstract: Objectives To investigate patterns of foot and ankle pain locations and symptoms, socio-demographic and comorbid characteristics to examine whether there are distinct foot and ankle pain phenotypes. Methods Adults aged ≥50 years registered with four general practices in North Staffordshire were mailed a Health Survey questionnaire. Participants reporting foot pain in the last month indicated foot pain location on a foot manikin. Foot and ankle pain patterns were investigated by latent class analysis. Associations between the classes with foot pain symptoms, socio-demographic and comorbid characteristics were assessed. Results Four thousand four hundred fifty-five participants with complete foot pain and manikin data were included in this analysis (mean age 65 years [SD 9.8], 49% male). Of those with foot and ankle pain (n = 1356), 90% had pain in more than one region. Six distinct classes of foot and ankle pain were identified: no pain (71%), bilateral forefoot/midfoot pain (4%), bilateral hindfoot pain (5%), left forefoot/midfoot pain (8%), right forefoot/midfoot pain (5%) and bilateral widespread foot and ankle pain (6%). People with bilateral widespread foot and ankle pain were more likely to be female, obese, depressed, anxious, have/had a manual occupation, have comorbidities, lower SF-12 scores and greater foot-specific disability. Age did not differ between classes. Conclusions Six distinct classes of foot and ankle pain locations were identified, and those with bilateral widespread foot and ankle pain had distinct characteristics. Further investigation of these individuals is required to determine if they have poorer outcomes over time and whether they would benefit from earlier identification and treatment.
TL;DR: In this article, the association between foot and ankle functional and structural characteristics with falls in community-dwelling older adults was investigated and a logistic regression analysis identified variables independently associated with falls.
TL;DR: In this paper, the authors describe patient and GP characteristics, and management actions for plantar heel pain in Australian general practice using data from the Bettering the Evaluation and Care of Health (BEACH) dataset.
Abstract: Background Studies have described general practitioner (GP) management of plantar heel pain from some countries; however, there is limited information from Australian general practice. Objectives To describe patient and GP characteristics, and management actions for plantar heel pain in Australian general practice. Design Secondary analysis of data from the Bettering the Evaluation and Care of Health (BEACH) dataset. Methods Data were summarised using descriptive analysis and robust 95% confidence intervals (CIs) were calculated around point estimates. Multivariate logistic regression identified predictors of plantar heel pain management. Results From 1,568,100 encounters between April 2000 and March 2016, plantar heel pain was managed at 3007 encounters. GPs manage plantar heel pain approximately once every 500 encounters, which extrapolates to 271,100 encounters in 2015-2016. Patient factors independently associated with plantar heel pain encounters included female sex (OR 1.27, 95% CI 1.17-1.34 cf. males), being aged 45-64 (OR 3.44, 95% CI 2.94-4.01 cf. aged 75+) and patients from a non-English speaking background (OR 1.22, 95% CI 1.07-1.39). Plantar heel pain was frequently managed using medication (45.1 per 100), with non-steroidal anti-inflammatory drugs the most common (22.8 per 100). GPs also commonly provided counselling/advice/education (32.4 per 100), and referrals for diagnostic imaging (19.1 per 100) and to podiatrists (12.0 per 100). Conclusions Plantar heel pain is a frequently managed foot condition in Australian general practice. GPs use medication, counselling and education, diagnostic imaging and referral to podiatrists for management. Further research is required to understand the drivers of these management actions and whether they are effective.
TL;DR: In this article, a cross-sectional observational study was conducted to determine if clinical measures of foot posture and ankle joint dorsiflexion differ in adults with and without plantar heel pain after accounting for body mass.
Abstract: Foot posture and ankle joint dorsiflexion have long been proposed to be risk factors for plantar heel pain, however body mass may be a confounder when investigating these factors. The aim of this study was to determine if clinical measures of foot posture and ankle joint dorsiflexion differ in adults with and without plantar heel pain after accounting for body mass. This was a cross-sectional observational study that compared 50 participants with plantar heel pain to 25 control participants without plantar heel pain who were matched for age, sex and body mass index. Foot posture was assessed using the Foot Posture Index and the Arch Index. Ankle joint dorsiflexion was assessed with a weightbearing lunge test with the knee extended and with the knee flexed. No significant differences (P < 0.05) were found between the groups for foot posture, whether measured with the Foot Posture Index or the Arch Index. Similarly, no significant differences were found in the weightbearing lunge test whether measured with the knee extended or with the knee flexed. Clinical measures of foot posture and ankle joint dorsiflexion do not differ in adults with and without plantar heel pain when body mass is accounted for. Therefore, clinicians should not focus exclusively on foot posture and ankle dorsiflexion and ignore the contribution of overweight or obesity.
TL;DR: To determine whether foot structure varies according to the presence and radiographic severity of first metatarsophalangeal (MTP) joint osteoarthritis (OA), X-ray diffraction analysis is used as a surrogate for EMT.
Abstract: OBJECTIVE To determine whether foot structure varies according to the presence and radiographic severity of first metatarsophalangeal (MTP) joint osteoarthritis (OA). METHODS Weight-bearing dorsiplantar and lateral radiographs were obtained for the symptomatic foot of 185 participants (105 women, ages 22-85 years) with clinically diagnosed first MTP joint OA. A validated atlas was used to classify participants as having radiographic first MTP joint OA and to stratify into 3 categories of severity (none/mild, moderate, severe). Bone length and width and angular measures of the forefoot and medial arch were performed on radiographs, and differences between categories were compared using univariate general linear models, adjusting for confounders. RESULTS A total of 150 participants were categorized as having radiographic first MTP joint OA, and participants were further stratified into none/mild (n = 35), moderate (n = 69), or severe (n = 81) OA categories. Participants with radiographically defined first MTP joint OA displayed a greater hallux abductus interphalangeal angle. Greater radiographic severity of first MTP joint OA was associated with a larger hallux abductus interphalangeal angle, a wider first metatarsal and proximal phalanx, and a smaller intermetatarsal angle. No differences in medial arch measurements were observed between the categories. CONCLUSION First ray alignment and morphology differed according to the presence and severity of first MTP joint OA. Prospective studies are required to determine whether the observed differences are a cause or consequence of OA.
TL;DR: The TREADON pilot and feasibility trial as mentioned in this paper was designed to compare the clinical and cost-effectiveness of self-management advice (SMA), individualised exercises and foot orthoses for plantar heel pain.
Abstract: Plantar heel pain (PHP) is common and impacts negatively on physical function and quality of life Initial treatment usually comprises analgesia and self-management advice (SMA), with referral to a physiotherapist or podiatrist recommended only when symptoms persist Systematic reviews highlight limitations of existing evidence for the effectiveness of exercises and orthoses The objective of the TREADON pilot and feasibility trial was to inform the design of a future main trial to compare the clinical and cost-effectiveness of self-management advice (SMA), individualised exercises and foot orthoses for PHP This was a four-arm randomised feasibility and pilot trial with 12-week follow-up Adults aged ≥ 18 years with PHP were identified from primary care by general practice consultation, retrospective general practice medical record review or a population survey Participants were randomised to either (i) SMA, (ii) SMA plus individualised exercises (SMA-exercises), (iii) SMA plus prefabricated foot orthoses (SMA-orthoses) or (iv) SMA plus combined individualised exercises and prefabricated foot orthoses (SMA-combined) Feasibility outcomes were recruitment; retention; intervention adherence, credibility and satisfaction; performance of three potential primary outcome measures (pain numeric rating scale (NRS), Foot Function Index-pain subscale (FFI-pain), Manchester Foot Pain and Disability Index-pain subscale (MFPDI-pain)); and parameters for informing the main trial sample size calculation Eighty-two participants were recruited All three identification methods met the target number of participants Retention at 12 weeks was 67% All interventions were successfully delivered as per protocol Adherence (range over 12 weeks 64–100%) and credibility (93%) were highest in the SMA-combined arm Satisfaction with treatment was higher for the three clinician-supported interventions (SMA 29%, SMA-exercises 72%, SMA-orthoses 71%, SMA-combined 73%) Responsiveness (baseline to 12 weeks) was higher for FFI-pain (standardised response mean 096) and pain NRS (104) than MFPDI-pain (057) Conservative sample size parameter estimates for standard deviation were pain NRS 25, FFI-pain 25 and MFPDI-pain 4, and baseline-outcome correlations were 05–06, 04 and < 03, respectively We demonstrated the feasibility of conducting a future main randomised clinical trial comparing the clinical and cost-effectiveness of SMA, exercises and/or foot orthoses for PHP ISRCTN 12160508
Prospectively registered 5th July 2016
TL;DR: In this article, the authors identify the need for effective and sustainable solutions for the issues with recruitment and retention of allied health professionals in metropolitan, rural, and remote locations, and identify the factors that influence workplace location choices when designing structures to attract and retain health care professionals.
Abstract: INTRODUCTION The maldistribution of health care workers between metropolitan, rural or remote areas is globally recognised. Allied health professional's workplace location choice is a complex interplay between professional and non-professional elements. Policy-makers should understand factors that influence workplace location choices when designing structures to attract allied health professionals to rural practice. OBJECTIVE To determine factors influencing recruitment and retention of allied health professionals in metropolitan, rural and remote locations. DESIGN Systematic review. FINDINGS Twenty-two studies met inclusion criteria. Extracted data were synthesised into subthemes: (a) opportunities for career development, (b) clinical load, (c) organisational and workplace structure, (d) previous location exposure and (e) personal factors. Of these 22 studies, 12 reported organisational/workplace structure and personal factors positively impacting recruitment and 11 studies discussed organisational and workplace structure also negatively impacting on retention. Career opportunities positively impacted on recruitment, while lack of opportunity negatively affected retention. Previous location exposure positively impacted recruitment however had limited impact on retention. Similarly, a diverse clinical load was reported as being attractive during recruitment, but unmanageable caseloads affected retention. DISCUSSION This review identifies the need for effective and sustainable solutions for the issues with recruitment and retention of allied health professionals. While the different allied health professions share similar recruitment and retention challenges, further research is needed to isolate factors impacting each discipline. CONCLUSIONS Retention and recruitment of different allied health professions is multifactorial. Organisational and workplace structure and opportunities for career development emerged as having impact on the recruitment of allied health professionals.
TL;DR: In this article, the authors found that the presence of first metatarsophalangeal joint OA was associated with increased severity of osteophytes, bone marrow lesions, subchondral cysts, effusion-synovitis, joint space narrowing, and cartilage loss.
Abstract: First metatarsophalangeal joint (MTP) joint osteoarthritis (OA) is prevalent, although the pathology of this condition is poorly understood. This study aimed to determine if there were differences in magnetic resonance imaging (MRI) characteristics of the first MTP joint between individuals with and without first MTP joint OA. This cross-sectional study compared 22 participants with first MTP joint OA to 22 control participants without first MTP joint OA (matched for age, sex, and body mass index). Participants underwent MRI of their first MTP joint and osteophytes, bone marrow lesions, subchondral cysts, effusion-synovitis, joint space narrowing, and cartilage loss were documented using an atlas of first MTP joint OA. Associations of MRI characteristics with the presence of first MTP joint OA were then determined. The presence of first MTP joint OA was associated with increased severity of osteophytes (dorsal metatarsal head, plantar metatarsal head, and dorsal proximal phalanx), bone marrow lesions (metatarsal head and proximal phalanx), cysts of the metatarsal head, effusion-synovitis (dorsal aspect), joint space narrowing (metatarsal-proximal phalanx; metatarsal-sesamoids), and cartilage loss. In contrast, there were no statistically significant associations for bone marrow lesions of the sesamoids, cysts of the proximal phalanx, or effusion-synovitis (plantar aspect). Osteophytes, bone marrow lesions, subchondral cysts, effusion-synovitis, joint space narrowing, and cartilage loss are characteristic MRI features of first MTP joint OA. First MTP joint OA is a disease of multiple joint tissues and this has implications for the assessment and management of this condition.
TL;DR: In this article, the authors examined the 12-month efficacy of high-volume injection (HVI) with corticosteroid and HVI without HVI versus sham injection among individuals with Achilles tendinopathy.
Abstract: Introduction Achilles tendinopathy (AT) is a common and disabling musculoskeletal condition. First-line management involving Achilles tendon loading exercise with, or without, other modalities may not resolve the problem in up to 44% of cases. Many people receive injections. Yet there are no injection treatments with demonstrated long-term efficacy. The aim of the trial is to examine the 12-month efficacy of high-volume injection (HVI) with corticosteroid and HVI without corticosteroid versus sham injection among individuals with AT. Methods and analysis The trial is a three-arm, parallel group, double-blind, superiority randomised controlled trial that will assess the efficacy of HVI with and without corticosteroid versus sham up to 12 months. We will block-randomise 192 participants to one of the three groups with a 1:1:1 ratio, and both participants and outcome assessors will be blinded to treatment allocation. All participants will receive an identical evidence-based education and exercise intervention. The primary outcome measure will be the Victorian Institute of Sport Assessment - Achilles (VISA-A) at 12 months post-randomisation, a validated, reliable and disease-specific measure of pain and function. Choice of secondary outcomes was informed by core outcome domains for tendinopathy. Data will be analysed using the intention-to-treat principle. Ethics and dissemination Ethics approval was obtained via the Monash University Human Ethics Committee (no: 13138). The study is expected to be completed in 2024 and disseminated via peer review publication and conference presentations. Trial registration number Australia and New Zealand Clinical trials registry (ACTRN12619001455156).
TL;DR: Foot OA is prevalent but neglected compared with other commonly affected sites such as the knee and hand, hence such a high-profile statement of need for foot Oa is long overdue.
Abstract: We read with great interest the editorial on foot osteoarthritis (OA) by Golightly and Gates (1). Foot OA is prevalent but neglected compared with other commonly affected sites such as the knee and hand (2), hence such a high-profile statement of need for foot OA is long overdue.
TL;DR: The authors concluded that referral to a podiatrist for custom insoles does not lead to better outcomes compared with usual GP care, and as such, healthcare providers should be ‘reserved’ in prescribing custom insole for the treatment of plantar heel pain.
Abstract: In British Journal of Sports Medicine , Rasenberg and colleagues1 report the findings of the Soles as Treatment Against Pain in feet (STAP) randomised trial comparing the effectiveness of usual general practitioner (GP) care to referral to a podiatrist for custom insoles or sham insoles in 185 people with plantar heel pain.1 After 12 weeks, the usual GP care group reported less pain during activity compared with the custom insole group (assessed using an 11-point Numerical Rating Scale), although this difference was small (less than one point) and did not meet the minimal clinically important difference for this outcome measure. Secondary outcomes favoured the GP group but were mostly small in magnitude. The authors concluded that referral to a podiatrist for custom insoles does not lead to better outcomes compared with usual GP care, and as such, healthcare providers should be ‘reserved’ in prescribing custom insoles for the treatment of plantar heel pain.
This is a generally well-designed pragmatic trial and the first to be undertaken in a primary care …