The effect of footwear with a flexible ankle collar on function in individuals with chronic ankle instability

Individuals who develop chronic ankle instability (CAI) following a lateral ankle sprain (LAS) often experience diminished proprioception, reduced dynamic stability, and altered movement patterns during landing (e.g. increased plantar flexion and inversion angles) (Simpson et al., Citation2019).Using external supports (e.g. ankle braces or taping) may reduce the risk of recurrent ankle sprains. However, disadvantages include discomfort, impaired athletic performance, and taping often requires application by a skilled practitioner and loosens over time (Koyama et al., Citation2014).Soft ankle collars are increasingly popular in sporting footwear, but it is not currently known if these provide positive benefits in individuals with CAI. Complete contact between the collar and the skin over the ankle joint could improve known deficits and ankle motion in CAI (Burcal et al., Citation2017)

An investigation into the effects of, and interaction between, heel height and shoe upper stiffness on plantar pressure and comfort

High heeled shoes remain popular, nevertheless it is not clear what influence manipulating characteristics of this footwear has on their functioning. It is accepted that shoe features other than heel height can affect plantar pressures. However, few investigations have compared such features, and none have compared the influence of modifying upper material stiffness, whilst systematically increasing heel height. A firm understanding of the interactions of footwear properties is essential to ensure that footwear designers can optimise design for the comfort and health of the wearer. This paper investigates a feature that is known to reduce comfort (heel height) and a feature that is easy to change without affecting aesthetics (material stiffness) to better understand the effects of their interaction on plantar pressure and comfort. Sixteen female participants with experience wearing high heels wore a range of shoes with five effective heel heights (35-75 mm) and two upper materials (with different stiffness). In-shoe plantar pressure was recorded and participants completed a comfort questionnaire. Increasing heel height increased plantar pressure under the metatarsal heads, while reducing pressure in the hallux and heel. Higher heel heights also lead to increased discomfort, particularly in the toes where discomfort increased 154.3% from the 35 to 75 mm heels. Upper stiffness did not affect plantar pressure. However, stiffer uppers significantly increased reported discomfort, most notably on top of the foot (108.6%), the back of the heel (87.7%), the overall width (99%), and the overall comfort (100.7%). Significant interaction effects between heel height and upper material existed for comfort questionnaire data. Manipulating heel height alters plantar pressure and comfort, and choice of upper material is paramount to achieving wearer comfort in heels

Is retail footwear fit for purpose for the feet of adults who are obese?

Background: The internal morphology and dimensions of shoes are determined by lasts on which they are manufactured, defined by foot shape, aesthetics and manufacturing requirements. Obese adults have larger foot dimensions with flatter morphology and report ill-fitting, uncomfortable footwear. Therefore, it is likely that lasts are not fit for purpose for this subset of around 30% of adults. This research quantified the relationship between the healthy weight foot and retail shoe and compared this with the foot of obese adults and wide-fit shoes targeted at those who are obese. Methods: A 3D foot scanner determined the morphology and dimensions of standard and wide-fit retail lasts and the feet of healthy weight and obese adults. Standard anatomical measurements and differences between multiple cross-sections of foot and lasts were compared with ANOVA. The relationship between a standard retail last and the foot of a healthy weight adult defined a level of acceptable difference in foot/last morphology/dimension, and was thus a benchmark to compare the difference between the obese foot and wide-fit last. Results: The comparison of standard measures demonstrated less spacious dimensions in the wide-fit shoes, specifically heel circumference and ball height. The cross-sectional analysis identified the wide-fit footwear has less spacious width in the rearfoot. In the midfoot and forefoot one of the wide-fit shoes exceeded the benchmark and provided significantly more space than the standard retail shoe. Conclusion: The results alluded to wide-fit footwear not currently being fit for purpose for obese adults; notably the footwear should be wider in the rearfoot. Meeting the footwear needs of the obese wearer may improve foot health and satisfaction, with potential benefits of increasing activity, consequently improving overall health

Does flip-flop style footwear modify ankle biomechanics and foot loading patterns?

Background Flip-flops are an item of footwear, which are rubber and loosely secured across the dorsal fore-foot. These are popular in warm climates; however are widely criticised for being detrimental to foot health and potentially modifying walking gait. Contemporary alternatives exist including FitFlop, which has a wider strap positioned closer to the ankle and a thicker, ergonomic, multi-density midsole. Therefore the current study investigated gait modifications when wearing flip-flop style footwear compared to barefoot walking. Additionally walking in a flip-flop was compared to that FitFlop alternative. Methods Testing was undertaken on 40 participants (20 male and 20 female, mean ± 1 SD age 35.2 ± 10.2 years, B.M.I 24.8 ± 4.7 kg.m−2). Kinematic, kinetic and electromyographic gait parameters were collected while participants walked through a 3D capture volume over a force plate with the lower limbs defined using retro-reflective markers. Ankle angle in swing, frontal plane motion in stance and force loading rates at initial contact were compared. Statistical analysis utilised ANOVA to compare differences between experimental conditions. Results The flip-flop footwear conditions altered gait parameters when compared to barefoot. Maximum ankle dorsiflexion in swing was greater in the flip-flop (7.6 ± 2.6°, p = 0.004) and FitFlop (8.5 ± 3.4°, p < 0.001) than barefoot (6.7 ± 2.6°). Significantly higher tibialis anterior activation was measured in terminal swing in FitFlop (32.6%, p < 0.001) and flip-flop (31.2%, p < 0.001) compared to barefoot. A faster heel velocity toward the floor was evident in the FitFlop (−.326 ± .068 m.s−1, p < 0.001) and flip-flop (−.342 ± .074 m.s−1, p < 0.001) compared to barefoot (−.170 ± .065 m.s−1). The FitFlop reduced frontal plane ankle peak eversion during stance (−3.5 ± 2.2°) compared to walking in the flip-flop (−4.4 ± 1.9°, p = 0.008) and barefoot (−4.3 ± 2.1°, p = 0.032). The FitFlop more effectively attenuated impact compared to the flip-flop, reducing the maximal instantaneous loading rate by 19% (p < 0.001). Conclusions Modifications to the sagittal plane ankle angle, frontal plane motion and characteristics of initial contact observed in barefoot walking occur in flip-flop footwear. The FitFlop may reduce risks traditionally associated with flip-flop footwear by reducing loading rate at heel strike and frontal plane motion at the ankle during stance

The manipulation of midsole properties to alter impact characteristics in walking

The midsole of footwear can provide an opportunity to attenuate the impact at the foot-ground interface. The present study was undertaken to quantify impact in walking in different footwear midsoles, comparing footwear thickness and hardness variations. Methods: Footbed thickness (28-41 mm) and hardness (30-55 Shore A) were varied independently in 7 flip-flops. Thirteen subjects walked in the footwear variations on a level walkway in the gait laboratory as lower limb kinematics, vertical ground reaction force and peak positive axial tibial acceleration were quantified. Peak magnitude and time of the acceleration were quantified and the heel-strike transient was characterised for comparison between conditions with a repeated-measures ANOVA. Thickness and hardness variations were also compared using a drop-test protocol to replicate walking. Results: Lower limb joint angles did not vary at heel-strike, however, a faster vertical heel-velocity was recorded in the softer midsoles (e.g. 55 Shore A = -0.294±0.055, 30 Shore A= -0.328±0.052, p<.001). Varying the hardness of the midsoles also significantly altered tibial acceleration and force variables, however limited significant differences existed between the thickness variations in walking. Increasing the hardness of the heel section of the footwear increased the peak positive axial tibial acceleration values, for example increasing Shore A from 30 to 40 resulted in a 35% increase in this variable. Concurrently, the occurrence of heel-strike transients increased from 5.8% in the 30 Shore A condition to 22.5%, 46.7% and 71.7% of all trials in the 40, 47 and 55 Shore A conditions respectively. The drop-test protocol replicated the differences evident in the walking protocol despite magnitudes being elevated. Conclusion: Modifying midsole properties of flip-flop footwear, particularly hardness, alters the gait kinematics and the shock experienced by the wearer in walking. This may pose benefits in terms of comfort and reduction in loading to the lower limb, however the influence on foot motion at initial contact and footwear longevity should be further quantified

High prevalence and two dominant host-specific genotypes of Coxiella burnetii in U.S. milk

BackgroundCoxiella burnetii causes Q fever in humans and Coxiellosis in animals; symptoms range from general malaise to fever, pneumonia, endocarditis and death. Livestock are a significant source of human infection as they shed C. burnetii cells in birth tissues, milk, urine and feces. Although prevalence of C. burnetii is high, few Q fever cases are reported in the U.S. and we have a limited understanding of their connectedness due to difficulties in genotyping. Here, we develop canonical SNP genotyping assays to evaluate spatial and temporal relationships among C. burnetii environmental samples and compare them across studies. Given the genotypic diversity of historical collections, we hypothesized that the current enzootic of Coxiellosis is caused by multiple circulating genotypes. We collected A) 23 milk samples from a single bovine herd, B) 134 commercial bovine and caprine milk samples from across the U.S., and C) 400 bovine and caprine samples from six milk processing plants over three years.ResultsWe detected C. burnetii DNA in 96% of samples with no variance over time. We genotyped 88.5% of positive samples; bovine milk contained only a single genotype (ST20) and caprine milk was dominated by a second type (mostly ST8).ConclusionsThe high prevalence and lack of genotypic diversity is consistent with a model of rapid spread and persistence. The segregation of genotypes between host species is indicative of species-specific adaptations or dissemination barriers and may offer insights into the relative lack of human cases and characterizing genotypes

Pediatric home mechanical ventilation: A Canadian Thoracic Society clinical practice guideline executive summary

Over the last 30 to 40 years, improvements in technology, as well as changing clinical practice regarding the appropriateness of long-term ventilation in patients with “non-curable” disorders, have resulted in increasing numbers of children surviving what were previously considered fatal conditions. This has come but at the expense of requiring ongoing, long-term prolonged mechanical ventilation (both invasive and noninvasive). Although there are many publications pertaining to specific aspects of home mechanical ventilation (HMV) in children, there are few comprehensive guidelines that bring together all of the current literature. In 2011 the Canadian Thoracic Society HMV Guideline Committee published a review of the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. This current document is intended to be a companion to the 2011 guidelines, concentrating on the issues that are either unique to children on HMV (individuals under 18 years of age), or where common pediatric practice diverges significantly from that employed in adults on long-term home ventilation. As with the adult guidelines,1 this document provides a disease-specific review of illnesses associated with the necessity for long-term ventilation in children, including children with chronic lung disease, spinal muscle atrophy, muscular dystrophies, kyphoscoliosis, obesity hypoventilation syndrome, and central hypoventilation syndromes. It also covers important common themes such as airway clearance, the ethics of initiation of long-term ventilation in individuals unable to give consent, the process of transition to home and to adult centers, and the impact, both financial, as well as social, that this may have on the child\u27s families and caregivers. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information

Accurate and Rapid Identification of the Burkholderia pseudomallei Near-Neighbour, Burkholderia ubonensis, Using Real-Time PCR

Burkholderia ubonensis is an environmental bacterium belonging to the Burkholderia cepacia complex (Bcc), a group of genetically related organisms that are associated with opportunistic but generally nonfatal infections in healthy individuals. In contrast, the near-neighbour species Burkholderia pseudomallei causes melioidosis, a disease that can be fatal in up to 95% of cases if left untreated. B. ubonensis is frequently misidentified as B. pseudomallei from soil samples using selective culturing on Ashdown&rsquo;s medium, reflecting both the shared environmental niche and morphological similarities of these species. Additionally, B. ubonensis shows potential as an important biocontrol agent in B. pseudomallei-endemic regions as certain strains possess antagonistic properties towards B. pseudomallei. Current methods for characterising B. ubonensis are laborious, time-consuming and costly, and as such this bacterium remains poorly studied. The aim of our study was to develop a rapid and inexpensive real-time PCR-based assay specific for B. ubonensis. We demonstrate that a novel B. ubonensis-specific assay, Bu550, accurately differentiates B. ubonensis from B. pseudomallei and other species that grow on selective Ashdown&rsquo;s agar. We anticipate that Bu550 will catalyse research on B. ubonensis by enabling rapid identification of this organism from Ashdown&rsquo;s-positive colonies that are not B. pseudomallei

Human CLEC9A antibodies deliver Wilms' tumor 1 (WT1) antigen to CD141+ dendritic cells to activate naïve and memory WT1‐specific CD8+ T cells

Objectives Vaccines that prime Wilms' tumor 1 (WT1)‐specific CD8+ T cells are attractive cancer immunotherapies. However, immunogenicity and clinical response rates may be enhanced by delivering WT1 to CD141+ dendritic cells (DCs). The C‐type lectin‐like receptor CLEC9A is expressed exclusively by CD141+ DCs and regulates CD8+ T‐cell responses. We developed a new vaccine comprising a human anti‐CLEC9A antibody fused to WT1 and investigated its capacity to target human CD141+ DCs and activate naïve and memory WT1‐specific CD8+ T cells. Methods WT1 was genetically fused to antibodies specific for human CLEC9A, DEC‐205 or β‐galactosidase (untargeted control). Activation of WT1‐specific CD8+ T‐cell lines following cross‐presentation by CD141+ DCs was quantified by IFNγ ELISPOT. Humanised mice reconstituted with human immune cell subsets, including a repertoire of naïve WT1‐specific CD8+ T cells, were used to investigate naïve WT1‐specific CD8+ T‐cell priming. Results The CLEC9A‐WT1 vaccine promoted cross‐presentation of WT1 epitopes to CD8+ T cells and mediated priming of naïve CD8+ T cells more effectively than the DEC‐205‐WT1 and untargeted control‐WT1 vaccines. Conclusions Delivery of WT1 to CD141+ DCs via CLEC9A stimulates CD8+ T cells more potently than either untargeted delivery or widespread delivery to all Ag‐presenting cells via DEC‐205, suggesting that cross‐presentation by CD141+ DCs is sufficient for effective CD8+ T‐cell priming in humans. The CLEC9A‐WT1 vaccine is a promising candidate immunotherapy for malignancies that express WT1