The Podiatry Research Group
Dr Angela Evans
Dr Sara Jones
Dr Rolf Scharfbillig
As part of the Podiatry Research Group we have been interested in a stream of research looking at the relationship between diabetes complications and pressure beneath the foot (plantar pressure). One of the complications of a diabetic foot is a loss of nerve function, known as neuropathy. It has been found that neuropathy and plantar pressures are major contributors to the breakdown of tissue integrity on the foot leading to ulceration, and in extreme cases amputation. The contribution of peripheral neuropathy to increased plantar pressures in individuals with or without diabetes is uncertain. The role of increased body mass on plantar pressures in the presence of loss of sensation is also unclear. And finally, the role some dressings, used to treat ulcers may have in altering plantar pressures is uncertain.
Thus we have undertaken a number of studies to investigate some of these issues. This included a study looking at the role of body mass increase on plantar pressures in a sensate foot (http://diabeticfootandankle.net/index.php/dfa/article/view/5518) and a study to see what the effect of commonly used foam dressings are on plantar pressures (http://diabeticfootandankle.net/index.php/dfa/article/view/8751). In an attempt to see how generalisable some of these findings will be to the neuropathic population the most recent study looked at artificially inducing plantar insensitivity to see if it mimics the findings in a truly neuropathic population. This is described in more detail below:
Plantar foot anaesthesia was achieved by inhibition of tibial nerve function with local anaesthetic. Nine asymptomatic adults were recruited. Plantar pressure variables of the right foot were collected using the Pedar-X pressure analysis in-shoe system (Novel, Munich, Germany). Comparison of the anaesthetised and sensate conditions showed a significant decrease in peak plantar pressure in the forefoot after plantar anaesthesia. An increase of 10 and 20% body mass after plantar anaesthesia showed a statistically significant increase in peak plantar pressure in the midfoot and hindfoot. A statistically significant increase in pressure time integral was only evident in the hindfoot after the addition of 20% body mass. The decreases in peak pressure are consistent with previous studies. Conversely, previous studies report pressure increases in people with Type 2 Diabetes and peripheral neuropathy. Therefore, the method used to mimic sensory loss in this study does not replicate the sensory loss seen in diabetes. It is hoped that future investigations will be undertaken on participants with peripheral neuropathy.
With the approach of the next Honours cohort from Podiatry and Physiotherapy, two projects that will be floated for prospective students include a Randomised controled trial (RCT) and an investigation into weight bearing and non weight bearing foot dorsiflexion.
In the first study, we plan to trial a moisturiser marketed as especially for diabetics against a placebo and a commonly used emollient. With a classic RCT design possible using these sort of interventions, we hope to randomly recruit from a population and produce a high level study.
Our second study will be looking at cohort comparison between a weight bearing and non-weight bearing foot dorsiflexion measure - both of which have shown excellent reliability, but show large differences in ranges measured. we hope this work will to go some way toward answering the question of which method is most reliable for the practitioner to assess foot dorsiflexion range.
We look forward to having the new students on board and welcome any enquiries regarding collaborations or suggestions for enhancing the studies briefly outlined. Contact: Dr Rolf Scharfbillig
Key projects and interests
Walk for Life
The Bangladesh Sustainable Club Foot Program.
Feet for Walking
These Feet were Made for Walking Clubfoot Project, Vietnam mission helping kids with clubfoot.
ABC for Diabetic Foot Assessment
Used in The Primary Care Side Bar Program through SA Health Connect.
See 2008 publications for related references to this project.
Attached is a list of selected research publications involving members of the Podiatry Research Group
Podiatry Research Group publications (PDF 186KB)
Helen Banwell firstname.lastname@example.org
Ryan Causby email@example.com
Hayley Uden firstname.lastname@example.org