Professional appraisal of online information about children’s footwear measurement and fit : readability, usability and quality

Parents increasingly use the internet to seek health information, share information and for purchasing textiles and footwear. This shift in footwear purchasing habits raises concern about how (and if) parents are getting their children's feet measured, and what support strategies are in place to support the fit of footwear. In response to this, some companies and healthcare organisations have developed resources to support home measurement of foot size, and link these measures to footwear selection, measurement and fitting. The aim of this research was to undertake an appraisal of web-based resources about measurement and fit of children's footwear, focussing specifically on readability, usability and quality. Search terms relating to children's foot measurement were compiled and online searching was undertaken. Search results were saved and screened for relevance. Existing resources were categorised based on their source e.g. a footwear company or a health website. The 15 most commonly identified resources were reviewed by a professional panel for readability, content, usability and validity. One researcher also assessed the accessibility and reading ease of the resources. Online resources were predominantly from commercial footwear companies (54%). Health information sources from professional bodies made up 4.2% of the resources identified. The top 15 resources had appropriate reading ease scores for parents (SMOG Index 4.3-8.2). Accessibility scores (the product of the number of times it appeared in search results and its ranking in the results) were highest for commercial footwear companies. The panel scores for readability ranged from 2.7 to 9 out of 10, with a similar range for content, usability and validity. Information for parents seeking to purchase footwear for their children is readily available online but this was largely dominated by commercial footwear companies. The quality and usability of this information is of a moderate standard; notable improvements could be made to the validity of the task the child is asked to undertake and the measures being taken. Improvements in these resources would improve the data input to the selection of footwear and therefore have a beneficial impact on footwear fit in children. [Abstract copyright: © The Author(s). 2020.

Symptomatic pes planus in children : a synthesis of allied health professional practices

This study sought to explore professional perspectives on the assessment and management of symptomatic pes planus in children. Data was collected from three professional groups (podiatrists, physiotherapists, and orthotists) with experience of managing foot problems in children. The survey was undertaken in the United Kingdom via a self-administered, online survey. Data was captured over a four-month period in 2018. Fifty-five health professionals completed the survey and the results highlighted that assessment techniques varied between professions, with standing tip-toe and joint range of motion being the most common. Treatment options for children were diverse and professionals were adopting different strategies as their first line intervention. All professions used orthoses. There were inconsistencies in how the health professionals assessed children presenting with foot symptoms, variation in how the condition was managed and differences in outcome measurement. These findings might be explained by the lack of robust evidence and suggests that more effort is needed to harmonise assessment and treatment approaches between professions. Addressing discrepancies in practice could help prioritise professional roles in this area, and better support the management of children with foot pain. [Abstract copyright: © The Author(s). 2020.

Variability in foot contact patterns in independent walking in infants

The purpose of this work was to quantify plantar pressures and contact areas (and variability thereof) in natural independent walking in infants

International approaches to paediatric podiatry curricula : it's the same, but different

Pre-registration / entry-level programmes of study provide the core knowledge, skills and abilities required for clinical practice. These programmes are where students are introduced to specialist domains of practice and begin to shape their professional interests. The aim of this research was to describe paediatric curricula within pre-registration and entry level podiatry programmes across comparable universities and offer a contemporary synthesis of international practices. An exploratory, cross-sectional, online survey was undertaken across a three-month period. Representatives from podiatry programmes delivering pre-registration or entry level podiatry degrees in which graduates are eligible for Professional and Statutory Body registration within their country (deemed at a Bachelor degree or higher), were invited to participate. The survey was administered online using Online Surveys. Descriptive statistics were used to describe the data due to the exploratory nature of the research question and design. There were responses from seven (54% of 13) universities in the United Kingdom (UK), nine (100% of nine) universities in Australia and four (50% of eight) of the invited universities external to the UK and Australia (New Zealand, Malta, Ireland, South Africa). There was some variation in curriculum content, but all universities reported to cover ontogeny and developmental milestones and general paediatric orthopaedic conditions. There was further discrepancy with the number of hours dedicated to paediatric podiatry within the curricula (ranging from  26 h). The findings from this study highlight some disparity in the delivery of training for students relating to paediatrics. The data suggests that there is a need for international coordination in establishing priorities for the paediatric curricula. This will ensure consistency in baseline knowledge, modes of training, amount and nature of curriculum delivery during undergraduate or entry level podiatry training

Alpha/beta and gamma interferons are induced by infection with noncytopathic bovine viral diarrhea virus in vivo

In contrast to the results of previous in vitro studies, experimental infection of calves with noncytopathic bovine viral diarrhea virus (ncpBVDV) was found to induce strong alpha/beta and gamma interferon responses in gnotobiotic animals. These responses were associated with depressed levels of transforming growth factor β (TGF-β) in serum. The results of this study indicate that the immunosuppression caused by ncpBVDV is not associated with low interferon responses or elevated levels of TGF-β

Time to revise our dialogue : how flat is the paediatric flatfoot?

A recent systematic review of measures of foot development used the medial longitudinal arch profile as its primary indicator of development. A comparative analysis of existing studies was undertaken. This work confirmed changes with arch profile were age-dependent, although the age at which foot development ceased remains unknown. This work also highlighted the abundance of clinical measures used in existing research and outlined the challenges with drawing consensus from available data. There is a clear need to move this debate forward and, to do so, it is essential that scientific and clinical communities unite. It is time to abandon ill-defined measures of foot position, look beyond the medial longitudinal arch as a sole parameter of foot development and re-focus our perspective(s) on the paediatric foot in order to make advances with clinical practice and research

First steps : parent health behaviours related to children’s foot health

Good foot health throughout childhood is important but remains poorly understood with few studies exploring this topic. The aim of this study was to define parents’ knowledge, practices and health-related perceptions of children’s feet. A qualitative design was adopted. Semi-structured, one-to-one interviews were carried out with parents of children aged five years and under, recruited from South East and North West of England. Interviews explored parents’ views, beliefs and understanding of foot health in infancy and early childhood. Transcripts of the interviews were analysed using thematic analysis. Eighteen interviews were conducted. Seven themes were identified relating to (1) parents belief and knowledge about children’s foot health; (2) how parents use and share foot health information; (3) activities for supporting foot health and development; (4) footwear choices, beliefs and influences; (5) the way they access health professionals; (6) the way they search for foot health information and (7) developing practice(s) to support parents. The study provides the first insight into how parents view foot health in early infancy and childhood. The findings highlight the key foot health beliefs important to parents, how they learn about and what influences their decision-making about caring for children’s feet, the way parents receive and seek information, and how they access support for foot health concerns. The findings highlight the need for accurate, clear and consistent foot health messages, and the important role health professionals have in signposting parents towards reliable and informative sources on foot health

Biomechanics of the infant foot during the transition to independent walking : a narrative review

Recognising structural and functional development of the paediatric foot is fundamental to ensuring a strong theoretical framework for health professionals and scientists. The transition of an infant from sitting to walking takes approximately 9 months and is when the structures and function of the foot must respond to the challenges of bearing load; becoming increasingly more essential for locomotion. Literature pertaining to the phase of development was searched. A narrative approach synthesised the information from papers written in English, with non-symptomatic infant participants up to the development stage of independent walking or two years of age. A range of literature was identified documenting morphological, physiological, neuromuscular and biomechanical aspects of the infant within this phase of development. The progression of variable gait to a regular pattern is documented within a range of studies focusing on neuromuscular control and ambulation development. However, methodological approaches may have compromised the external validity of such data. Additionally, limited consideration for the specific function and development of the foot is evident, despite its role as the primary site of weight bearing and interface with the floor. A lack of consideration of infants prior to ambulation (i.e. before cruising or walking) is also apparent which prevents a reference baseline being used effectively. This review also identifies future research priorities such that a comprehensive understanding of foot development from a non-weight bearing to a weight bearing structure during locomotor advancement can be gained

Keratin 6a marks mammary bipotential progenitor cells that can give rise to a unique tumor model resembling human normal-like breast cancer.

Progenitor cells are considered an important cell of origin of human malignancies. However, there has not been any single gene that can define mammary bipotential progenitor cells, and as such it has not been possible to use genetic methods to introduce oncogenic alterations into these cells in vivo to study tumorigenesis from them. Keratin 6a is expressed in a subset of mammary luminal epithelial cells and body cells of terminal end buds. By generating transgenic mice using the Keratin 6a (K6a) gene promoter to express tumor virus A (tva), which encodes the receptor for avian leukosis virus subgroup A (ALV/A), we provide direct evidence that K6a(+) cells are bipotential progenitor cells, and the first demonstration of a non-basal location for some biopotential progenitor cells. These K6a(+) cells were readily induced to form mammary tumors by intraductal injection of RCAS (an ALV/A-derived vector) carrying the gene encoding the polyoma middle T antigen. Tumors in this K6a-tva line were papillary and resembled the normal breast-like subtype of human breast cancer. This is the first model of this subtype of human tumors and thus may be useful for preclinical testing of targeted therapy for patients with normal-like breast cancer. These observations also provide direct in vivo evidence for the hypothesis that the cell of origin affects mammary tumor phenotypes

Spatially and genetically distinct African trypanosome virulence variants defined by host interferon-g response

We describe 2 spatially distinct foci of human African trypansomiasis in eastern Uganda. The Tororo and Soroti foci of <i>Trypanosoma brucei rhodesiense</i> infection were genetically distinct as characterized by 6 microsatellite and 1 minisatellite polymorphic markers and were characterized by differences in disease progression and host-immune response. In particular, infections with the Tororo genotype exhibited an increased frequency of progression to and severity of the meningoencephalitic stage and higher plasma interferon (IFN)–γ concentration, compared with those with the Soroti genotype. We propose that the magnitude of the systemic IFN-γ response determines the time at which infected individuals develop central nervous system infection and that this is consistent with the recently described role of IFN-γ in facilitating blood-brain barrier transmigration of trypanosomes in an experimental model of infection. The identification of trypanosome isolates with differing disease progression phenotypes provides the first field-based genetic evidence for virulence variants in T. <i>brucei rhodesiense</i>