An investigation into the cause of the inner dark areas and outer lighter areas (ghosting) seen in dynamically-created two-dimensional bare footprints

Dynamic bare footprints differ from static bare footprints through the presence of additional, lighter markings around the rear of the heel print and apices of the toe print areas. These images can appropriately be described as inner dark and outer ghosting features. To date, the functional cause of both features has not been understood. To gain such an understanding could potentially allow the further development and use of these features in forensic identification. The aim of this project was to investigate the causes of the inner dark and outer ghosting features seen in dynamic bare footprints through an observational, practice-based action research approach within a gait laboratory. Volunteer male participants provided bare footprints on inkless paper taped to a Kistler force plate with video cameras situated either side. Ground reaction force data were collected as the footprints were formed and the event recorded using video cameras to allow these data to be correlated later. The findings suggest that the ghosting at the heel is the result of splaying of the fibro fatty pad, while that at the toes is the result of the distal ends of the toes coming into contact with the ground as the heel is lifted. Footprint, ground reaction force and video data comparisons showed that the inner dark area of the heel print corresponded with the main body of the heel contacting the ground. Outer ghosting corresponded with a backward splaying of the fat pad and the heel strike transient spike in vertical ground reaction force during increased loading. The inner dark area of the toes corresponded with a longer period of toe contact with the ground. Outer ghosting corresponded with the decreasing vertical ground reaction force and shorter contact time as the toes were leaving the ground towards the end of the contact phase of gait. Although the sample size was limited, these are new appreciations which could facilitate the use of the inner dark features in identification to provide additional points for comparison in cases involving dynamic bare footprints. Further work is now indicated to study these features in different populations and under varying conditions

If the shoe fits : Development of an on-line tool to aid practitioner/patient discussions about 'healthy footwear'

Background: A previous study highlighted the importance of footwear to individuals' sense of their identity, demonstrating that shoes must 'fit' someone socially, as well as functionally. However, unhealthy shoes can have a detrimental effect on both foot health and mobility. This project utilises qualitative social science methods to enable podiatrists to understand the broader contribution of footwear to patients' sense of themselves and from this an online toolkit was developed to aid footwear education. Method: Semi-structured interviews were conducted with six podiatrists/shoe-fitters and 13 people with foot pathologies, some of whom also completed shoe diaries. These were supplemented with some follow-up interviews and photographs of participants' own shoes were taken to allow in-depth discussions. Results: Four areas related to 'fit' were identified; practicalities, personal, purpose and pressures, all of which need to be considered when discussing changes in footwear. These were incorporated into an online toolkit which was further validated by service users and practitioners in a focus group. Conclusion: This toolkit can support podiatrists in partnership with patients to identify and address possible barriers to changing footwear towards a more suitable shoe. Enabling patients to make healthier shoe choices will help contribute to improvements in their foot health and mobility

Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people : a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial)

BACKGROUND: Falls are a serious cause of morbidity and cost to individuals and society. Evidence suggests that foot problems and inappropriate footwear may increase the risk of falling. Podiatric interventions could help reduce falls; however, there is limited evidence regarding their clinical effectiveness and cost-effectiveness. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for preventing falls in community-dwelling older people at risk of falling, relative to usual care. DESIGN: A pragmatic, multicentred, cohort randomised controlled trial with an economic evaluation and qualitative study. SETTING: Nine NHS trusts in the UK and one site in Ireland. PARTICIPANTS: In total, 1010 participants aged ≥ 65 years were randomised (intervention, n = 493; usual care, n = 517) via a secure, remote service. Blinding was not possible. INTERVENTIONS: All participants received a falls prevention leaflet and routine care from their podiatrist and general practitioner. The intervention also consisted of footwear advice, footwear provision if required, foot orthoses and foot- and ankle-strengthening exercises. MAIN OUTCOME MEASURES: The primary outcome was the incidence rate of falls per participant in the 12 months following randomisation. The secondary outcomes included the proportion of fallers and multiple fallers, time to first fall, fear of falling, fracture rate, health-related quality of life (HRQoL) and cost-effectiveness. RESULTS: The primary analysis consisted of 484 (98.2%) intervention and 507 (98.1%) usual-care participants. There was a non-statistically significant reduction in the incidence rate of falls in the intervention group [adjusted incidence rate ratio 0.88, 95% confidence interval (CI) 0.73 to 1.05; p = 0.16]. The proportion of participants experiencing a fall was lower (50% vs. 55%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00; p = 0.05). No differences were observed in key secondary outcomes. No serious, unexpected and related adverse events were reported. The intervention costs £252.17 more per participant (95% CI -£69.48 to £589.38) than usual care, was marginally more beneficial in terms of HRQoL measured via the EuroQoL-5 Dimensions [mean quality-adjusted life-year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314 QALYs] and had a 65% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of £30,000 per QALY gained. The intervention was generally acceptable to podiatrists and trial participants. LIMITATIONS: Owing to the difficulty in calculating a sample size for a count outcome, the sample size was based on detecting a difference in the proportion of participants experiencing at least one fall, and not the primary outcome. We are therefore unable to confirm if the trial was sufficiently powered for the primary outcome. The findings are not generalisable to patients who are not receiving podiatry care. CONCLUSIONS: The intervention was safe and potentially effective. Although the primary outcome measure did not reach significance, a lower fall rate was observed in the intervention group. The reduction in the proportion of older adults who experienced a fall was of borderline statistical significance. The economic evaluation suggests that the intervention could be cost-effective. FUTURE WORK: Further research could examine whether or not the intervention could be delivered in group sessions, by physiotherapists, or in high-risk patients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN68240461. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 24. See the NIHR Journals Library website for further project information

A Nested Randomised Controlled Trial of a Newsletter and Post-it Note Did not Increase Postal Questionnaire Response Rates in a Falls Prevention Trial

Background: Attrition (i.e. when participants do not return the questionnaires)is a problem for many randomised controlled trials. The resultant loss of dataleads to a reduction in statistical power and can lead to bias. The aim of thisstudy was to assess whether a pre-notification newsletter and/or a handwrittenor printed Post-it® note sticker, as a reminder, increased postal questionnaireresponse rates for participants of randomised controlled trials.Method: This study was a factorial trial embedded within a trial of afalls-prevention intervention among men and women aged ≥65 years underpodiatric care. Participants were randomised into one of six groups: newsletterplus handwritten Post-it®; newsletter plus printed Post-it®; newsletter only;handwritten Post-it® only; printed Post-it® only; or no newsletter or Post-it®.The results were combined with those from previous embedded randomisedcontrolled trials in a meta-analysis.Results: The 12-month response rate was 803/826 (97.2%) (newsletter 95.1%,no newsletter 99.3%, printed Post-it® 97.5%, handwritten Post-it® 97.1%, noPost-it® 97.1%). Pre-notification with a newsletter had a detrimental effect onresponse rates (adjusted odds ratio (OR), 0.14; 95% CI, 0.04 to 0.48; p<0.01)and time to return the questionnaire (adjusted hazard ratio, 0.86; 95% CI, 0.75to 0.99; p=0.04). No other statistically significant differences were observedbetween the intervention groups on response rates, time to response, and theneed for a reminder.Conclusions: Post-it® notes have been shown to be ineffective in threeembedded trials, whereas the evidence for newsletter reminders is stilluncertain.KeywordsRandomised controlled trial; randomisation; embedded trial; newsletter;Post-it® note; response rat

'A good fit?' Bringing the Sociology of Footwear to the Clinical Encounter in Podiatry Services : A Narrative Review

Background: This narrative review explores the ways in which drawing on theories and methods used in sociological work on footwear and identity can contribute to healthcare research with podiatrists and their patients, highlighting recent research in this field, implications for practice and potential areas for future development. Traditionally, research within Podiatry Services has tended to adopt a quantitative, positivist focus, developing separately from a growing body of sociological work exploring the importance of shoes in constructing identity and self-image. Bringing qualitative research drawing on sociological theory and methods to the clinical encounter has real potential to increase our understanding of patient values, motivations and – crucially – any barriers to adopting ‘healthier’ footwear that they may encounter. Such work can help practitioners to understand why patients may resist making changes to their footwear practices, and help us to devise new ways for practitioners to explore and ultimately break down individual barriers to change (including their own preconceptions as practitioners). This, in turn, may lead to long-term, sustainable changes to footwear practices and improvements in foot health for those with complex health conditions and the wider population. Conclusion: A recognition of the complex links between shoes and identity is opening up space for discussion of patient resistance to footwear changes, and paving the way for future research in this field beyond the temporary ‘moment’ of the clinical encounter

Cohort Randomised Controlled Trial of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People (The REFORM Trial)

BACKGROUND: Falls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention. DESIGN: Pragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness. RESULTS: In the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained. CONCLUSION: There was a small reduction in falls. The intervention may be cost-effective. TRIAL REGISTRATION: ISRCTN ISRCTN68240461