Standardising foot assessment to improve amputation rates.

In Australia, diabetes-related foot disease results in an ~27,600 public hospital admissions, 4,400 lower extremity amputations and 1,700 deaths every year, at a cost to the health system of $1.6 billion per annum. In fact, amputation rates have risen 30% in the past decade. Guidelines suggest that amputation risk can be reduced with quality assessment, evidence-based management and appropriate education.

Standardising Assessment, Risk and Referral in the Diabetic foot (StandARRD) diagram

The Standardising Assessment, Risk and Referral in the Diabetic foot (StandARRD) electronic foot health package (2019 – 2023) aims to prevent and improve management of foot ulceration risk in people with diabetes-related foot disease by incorporating all these points. For use by podiatrists, diabetes educators, RNs and any other health professionals involved in diabetes and foot health, the StandARRD package will:

  1. i) consistently stratify risk of foot ulceration based on each person’s screening/assessment outcomes
  2. ii) have user-engaged evidence-based education resources that can be targeted according to assessment outcomes, and
  3. iii) facilitate communication between allied health and general practitioners, enabling rapid communication of ulceration risk and management requirements by integrating with widely used clinical software.

This project is currently using a consensus method to develop the assessment protocol for the tool by asking expert podiatrists from all over the world to design the ultimate in diabetic foot screening. The next stage will involve developing evidence-based educational units in conjunction with people with diabetes and then we will pull it all together in an electronic platform that will talk to different versions of clinical record keeping packages.

The Paediatric Foot Population Study (PFPS): Defining the typical development of the paediatric foot from 2 to 12 years of age

We know that the child’s foot should be flat and slowly develop an arch during the first 10 years of life. What is not known is; How flat it should be at each and every year increase? and at what age the foot ceases to develop further? Without this information, the clinician is making management based decisions primarily determined by their own clinical experience. This subjective process leads to ethical conundrums around charging families for therapies with little to no evidence to support their use.

The PFPS will be a large population-based study to robustly measure the foot posture of children and produce percentile charts detailing the foots development. From this point forward clinical areas of interest are then able to be studied; for e.g. which paediatric foot posture would be most likely to become problematic? and, which foot posture will benefit most from orthotic therapy? Until the typical trajectory is adequately charted, these types of important clinical questions cannot be addressed. We are currently recruiting for this study. If you are interested, please contact the researchers via the contact us tab on the webpage or via email here.

Using an iPhone to measure ankle joint range of motion

Adequate ankle joint range of motion (ROM) is a requirement for effective gait. When the ankle has a limited range of available motion, compensations often occur through other joints, such as hyper-extension of the knee or an abducted foot position. Limited ankle joint ROM also impedes our ability to run, squat and jump – all the things children (in particular) often do during normal daily activities. As such, health professions routinely measure ankle joint ROM through the weight-bearing lunge test, with strengthening and stretching routines advised where limitations are found.

We are running a series of separate studies this year to determine if the inclinometer freely available on an iPhone (it’s under the compass app, swipe left) is reliable enough that we can have people use it at home to measure whether their ROM is improving. We will determine this in adults (healthy norms) and two populations of children (both with underlying medical conditions). The data collection for these studies will be finalised by December 2018. 

Investigating balance differences between children with neurological concerns and those typically developing

Difficulties in balance is one of the measures used to determine if i) a person has an underlying neurological condition such as developmental coordination disorder (DCD), or ii) the severity of effects of known conditions such as cerebral palsy. What is not clearly understood, however, is how different a child’s balance is when they have one of these conditions when compared to children of the same age that are typically developing.

This study will search the literature for populations of children with diagnosed DCD and cerebral palsy to determine if statistically significant differences are observed for balance between the condition and healthy norms. This will inform the research team if further research is required around improving balance with good quality foot wear or in-shoe inserts. It is still very early days for this research but we hope to have something ready to report in 2019.

Balance in Girls: Exploring postural control in 8 - 10-year-old girls

Girls have been shown to lag behind boys when it comes to their motor skills (e.g. ball skills) and physical activity. Having good balance in an essential part of being able to perform more complex movement skills like kicking a ball, catching, throwing, running and jumping. Our prior research shows that girls may be at risk of poor balance and that a range of factors might be important. This research may inform strategies to promote balance and movement skills in girls – that way, we can set girls up for success in sport and physical activity and ultimately, better health in the long-term. We have finished recruiting for this study and are busy analysing our results – we hope to publish our findings shortly. This study was funded by the AMP Foundation.