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Biomedical subjects

J Woodburn

Publications and source records attributed to J Woodburn.

11 recordsLinked to original sources
PubMed2004

Debridement of plantar callosities in rheumatoid arthritis: a randomized controlled trial.

OBJECTIVE: To compare forefoot pain, pressure and function before and after normal and sham callus treatment in rheumatoid arthritis (RA). PATIENTS AND METHODS: Thirty-eight RA patients were randomly assigned to normal (NCT group) or sham (SCT) scalpel debridement. The sham procedure comprised blunt-edged scalpel paring of the callus which delivered a physical stimulus but left the hyperkeratotic tissue intact, the procedure being partially obscured from the patient. Forefoot pain was assessed using a 100 mm visual analogue scale (VAS), pressure using a high-resolution foot pressure scanner and function using the spatial-temporal gait parameters measured on an instrumented walkway. Radiographic scores of joint erosion were obtained for metatarsophalangeal (MTP) joints with and without overlying callosities. The trial consisted of a randomized sham-controlled phase evaluating the immediate same-day treatment effect and an unblinded 4-week follow-up phase. RESULTS: During the sham-controlled phase, forefoot pain improved in both groups by only 3 points on a VAS and no statistically significant between-group difference was found (P = 0.48). When data were pooled during the unblinded phase, the improvement in forefoot pain reached a peak after 2 days and gradually lessened over the next 28 days. Following debridement, peak pressures at the callus sites decreased in the NCT group and increased in the SCT group, but there was no statistically significant between-group difference (P = 0.16). The area of and duration of contact of the callus site on the ground remained unchanged following treatment in both groups. Following debridement, walking speed was increased, the stride-length was longer and the double-support time shorter in both groups; however, between-group differences did not reach levels of statistical significance. MTP joints with overlying callus were significantly more eroded than those without (P = 0.02). CONCLUSIONS: Treatment of painful plantar callosities in RA using scalpel debridement lessened forefoot pain but the effect was no greater than sham treatment. Localized pressure or gait function was not significantly improved following treatment.

Adult↗
PubMed2002

Three-dimensional kinematics at the ankle joint complex in rheumatoid arthritis patients with painful valgus deformity of the rearfoot.

OBJECTIVE: To evaluate the three-dimensional (3D) kinematics of the ankle joint complex (AJC) in rheumatoid arthritis (RA) patients with painful valgus deformity of the rearfoot. METHODS: Fifty patients with RA underwent gait analysis using electromagnetic tracking techniques to measure 3D kinematics at the AJC under barefoot and shod walking conditions. Three axial rotations (dorsiflexion/plantarflexion, inversion/eversion and internal/external rotation) were measured during the gait cycle, and the angular positions at key gait events, range of motion and the motion: time integral were measured. Descriptive and analytical comparisons were made with normative data derived from a sex- and age-matched population (n=45). RESULTS: AJC dysfunction in RA was characterized by excessive eversion motion (within an eversion range) and no inversion motion through the neutral joint position for the subtalar component of the joint complex, in both barefoot and shod walking conditions. Motion was coupled such that internal rotation of the leg relative to the rearfoot was greater than normal. AJC motion was different for all rotations between barefoot and shod conditions, but in both situations there were statistically significant between-group differences in the motion:time integral for inversion/eversion (barefoot, P<0.0001; shod, P<0.0001) and external/internal rotation (barefoot, P<0.0001; shod, P<0.0001). There were no statistically significant differences between RA and normative data for dorsiflexion/plantarflexion motion under barefoot (P=0.16) and shod (P=0.50) walking conditions. CONCLUSION: Painful valgus deformity of the rearfoot is associated with changes in the 3D kinematics affecting eversion at the AJC and internal rotation of the leg, both when walking barefoot and in shoes.

Adult↗
PubMed2000

Preliminary investigation of debridement of plantar callosities in rheumatoid arthritis.

OBJECTIVE: To determine the effect of expert debridement of foot callosities on forefoot pain and plantar pressure distribution in rheumatoid arthritis (RA). METHODS: Plantar callosities on 14 feet of eight RA patients were debrided by a single podiatrist. Measurements of subjective pain severity in the forefoot and global arthritis pain were undertaken using a visual analogue scale, repeated at 7-day intervals to the next treatment (28 days). Plantar pressures were recorded at the lesion sites using an in-shoe flexible transducer insole before and after lesion debridement. RESULTS: Following debridement, all patients reported symptomatic relief with an average change in pain score of 48% (P = 0.01) but the treatment effect was lost by 7 days. Immediately following scalpel debridement, peak pressures were elevated in 10 of 14 feet, whilst contact time was reduced and peak force increased. None, however, reached statistical significance. CONCLUSION: Scalpel debridement of forefoot plantar callosities reduces forefoot pain for about 7 days, but pressure distribution is not significantly altered.

Aged↗
PubMed1999

A preliminary study determining the feasibility of electromagnetic tracking for kinematics at the ankle joint complex.

OBJECTIVE: To determine the feasibility of using electromagnetic tracking (EMT) for quantifying three-dimensional kinematics at the ankle joint complex (AJC). METHODS: AJC kinematics were recorded in 10 normal healthy adults, and 10 rheumatoid arthritis patients presenting with AJC instability and deformity who were undergoing footwear and orthotic intervention. RESULTS: Kinematics in normal subjects had strong face validity, curve shape showing moderate (n=9), good (n=8) or excellent (n=4) agreement with data from seven published studies. The range of motion about the x-axis (15.2 degrees ) was similar to reference values (17.0 degrees ), but our technique underestimated rotations about the y- (8.1 degrees vs 14.0 degrees ) and z-axes (7.7 degrees vs 12.2 degrees ). In the rheumatoid arthritis pronated foot group, eversion and internal rotation during the stance phase of gait were between 2 and 5 times greater than for normal subjects. The use of a corrective foot orthosis in this group restored normal kinematics, reducing maximum eversion and internal rotation by 57 and 68%, respectively. CONCLUSION: A new technique for measuring kinematics at the AJC is described. Based upon the findings of this pilot study, EMT may be useful for diagnosing AJC dysfunction and quantifying the mechanical efficacy of footwear and orthosis interventions.

Adult↗
PubMed1997

Observations on the F-Scan in-shoe pressure measuring system.

BACKGROUND:: F-Scan (Tekscan Inc.) is a commercial in-shoe force/pressure measurement system. The system has been used in a number of useful clinical studies focused mainly on the evaluation of various therapeutic measures including footwear and in-shoe orthoses. More recently, the accuracy and reliability of the system has come under closer scrutiny, highlighting the need for further debate supported by experimental studies. We have critically evaluated the performance of the F-Scan sensor and report here on bench test findings examining calibration error, hysteresis and creep, and the accuracy and repeatability of output force measurements. METHOD:: The F-Scan system was used to measure output mass following calibration using the standard protocol across a range of subject determined input masses. A small jig-mounted force meter was used to test groups of individual sensing units (4 @ cm(2)) for within and between sensor accuracy in full size and adjusted sensors. An Instron servohydraulic materials testing unit was used to evaluate creep, hysteresis and the repeatability of output forces over repeated loading cycles for full size and cut sensors. RESULTS:: Average calibration error: 4% Creep: 19% Hysteresis: 21% [Table: see text] CONCLUSION:: 1. The F-Scan calibration protocol is inaccurate. 2. Significant within and between sensor variability in output forces can be expected. 3. The creep and hysteresis properties of the sensor are poor. 4. The F-Scan sensor does not yield repeatable measurements. 5. When the sensor is adjusted to a smaller size output is adversely affected. The F-Scan system has a limited capability for absolute accuracy but may be used for quantitative studies provided its limitations are noted.

Journal Article↗
PubMed1996

Observations on the F-Scan in-shoe pressure measuring system.

OBJECTIVE: To evaluate the physical characteristics (durability, calibration, creep and hysteresis) and the accuracy and repeatability of the F-Scan in-shoe sensor. DESIGN: Observations of the system in clinical use combined with material bench-test experiments. BACKGROUND: The F-Scan system is a commercially produced in-shoe force/pressure measurement system. Whilst useful clinical studies have been reported there is little information on the performance characteristics of the system. METHODS: Output mass error following calibration was directly measured from the F-Scan system. A jig-mounted force meter tested groups of individual sensing units (4 @ 1 cm(-2)) for within and between sensor accuracy in full size and adjusted sensors. An Instron servohydraulic materials testing unit was used to evaluate creep, hysteresis and the repeatability of output forces over repeated loading cycles for full size and cut sensors. RESULTS: The F-Scan system lacks durability and suffers significant calibration error. Creep (19%) and hysteresis (21%) properties were poor. Within and between sensor variability in output was demonstrated and overall repeatability was poor. Adjusting the sensor size adversely affects output. CONCLUSIONS: Our findings suggest the F-Scan system has a limited capability for absolute accuracy but could still be used for quantitative studies provided its limitations are noted. RELEVANCE: These findings may help F-Scan users evaluate the relevance of clinical data and refine measurement protocols in the context of their own field of work.

Journal Article↗
PubMed1996

Relation between heel position and the distribution of forefoot plantar pressures and skin callosities in rheumatoid arthritis.

OBJECTIVE: To investigate the relation between the position of the rearfoot and the distribution of forefoot plantar pressures and skin callosities in rheumatoid arthritis. METHOD: Plantar pressures and callosity patterns were measured in 102 rheumatoid arthritis patients (120 feet with normal heel alignment and 84 feet with valgus heel alignment measured by goniometry) and in 42 (84 feet) age matched healthy adults. Peak pressures (kPa) were measured across the metatarsal heads in-shoe using an FScan system and the distribution of plantar callosities was visually mapped for each foot. RESULTS: Peak pressures were significantly greater at all but the first metatarsal head in the rheumatoid normal heel alignment and healthy adult groups than in the rheumatoid valgus heel group. The feet of both the rheumatoid normal heel group and the healthy adult group behaved the same, the highest peak pressures registering on the central metatarsal heads. However, only in the rheumatoid group were plantar callosities found at these sites. In the rheumatoid valgus heel group, lateral metatarsal heads were frequently non-weightbearing, producing gross loading patterns with a dominant medial distribution. Peak pressures were shifted to the medial fore-foot accompanied by a higher prevalence of callosities. The results, however, failed to establish clearly an association between peak pressures and callus formation. CONCLUSIONS: In rheumatoid arthritis there is an important interrelation between the rearfoot position and forefoot pressure sites.

Adolescent↗