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"Foot diseases"
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Validation of PROMIS® Physical Function Computerized Adaptive Tests for Orthopaedic Foot and Ankle Outcome Research
Background
In 2012, the American Orthopaedic Foot & Ankle Society
®
established a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the network’s initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting.
Questions/purposes
We determined whether the CAT from the NIH Patient Reported Outcome Measurement Information System
®
(PROMIS
®
) Physical Function (PF) item bank provides efficient, reliable, valid, precise, and adequately covered point estimates of patients’ physical function.
Methods
After informed consent, 288 patients with a mean age of 51 years (range, 18–81 years) undergoing surgery for common foot and ankle problems completed a web-based questionnaire. Efficiency was determined by time for test administration. Reliability was assessed with person and item reliability estimates. Validity evaluation included content validity from expert review and construct validity measured against the PROMIS
®
Pain CAT and patient responses based on tradeoff perceptions. Precision was assessed by standard error of measurement (SEM) across patients’ physical function levels. Instrument coverage was based on a person-item map.
Results
Average time of test administration was 47 seconds. Reliability was 0.96 for person and 0.99 for item. Construct validity against the Pain CAT had an r value of −0.657 (p < 0.001). Precision had an SEM of less than 3.3 (equivalent to a Cronbach’s alpha of ≥ 0.90) across a broad range of function. Concerning coverage, the ceiling effect was 0.32% and there was no floor effect.
Conclusions
The PROMIS
®
PF CAT appears to be an excellent method for measuring outcomes for patients with foot and ankle surgery. Further validation of the PROMIS
®
item banks may ultimately provide a valid and reliable tool for measuring patient-reported outcomes after injuries and treatment.
Level of Evidence
Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
Journal Article
Effects of customized orthoses on foot morphology and pressure in patients with accessory navicular syndrome
Objective
This study aimed to assess the effects of customized orthoses on foot morphology and plantar pressure in professional athletes with accessory navicular syndrome (ANS) over a 12-month period, compared to conventional insoles.
Methods
In this randomized controlled study, 54 pro athletes with medial foot pain, diagnosed with ANS, joined after 3-month training. Split into two groups: custom orthotics (intervention) or regular insoles (control). Evaluated at 3, 6, 12 months on foot structure (arch, navicular, etc.) and function (pressure, force-time integral, VAS pain). Found significant improvements in intervention group’s foot shape, pressure distribution, and pain reduction compared to controls.
Results
Compared to the control group, the intervention group showed significant increases in arch angle and arch height across all assessment intervals (
P
< 0.05). Additionally, heel eversion angle and navicular prominence distance significantly decreased in the intervention group compared to controls (
P
< 0.05). Pressure and force-time integral values at the first metatarsal head, medial arch, and medial heel significantly decreased, while lateral arch loading increased in the intervention group (
P
< 0.05). VAS scores for foot pain significantly decreased in the intervention group compared to controls (
P
< 0.05).
Conclusion
Customized orthoses effectively improved foot morphology and reduced plantar pressure in professional athletes with ANS compared to conventional insoles. These findings suggest that customized orthotic intervention provides faster and more significant pain relief for patients with ANS-related medial arch collapse.
Trial registration
Chinese Clinical Trial Registry (ChiCTR2500100238; Retrospectively registered on 04/07/2025).
Journal Article
Relationship Between Clinical Signs and Transmission of an Infectious Disease and the Implications for Control
Control of many infectious diseases relies on the detection of clinical cases and the isolation, removal, or treatment of cases and their contacts. The success of such \"reactive\" strategies is influenced by the fraction of transmission occurring before signs appear. We performed experimental studies of foot-and-mouth disease transmission in cattle and estimated this fraction at less than half the value expected from detecting virus in body fluids, the standard proxy measure of infectiousness. This is because the infectious period is shorter (mean 1.7 days) than currently realized, and animals are not infectious until, on average, 0.5 days after clinical signs appear. These results imply that controversial preemptive control measures may be unnecessary; instead, efforts should be directed at early detection of infection and rapid intervention.
Journal Article
An Inactivated Enterovirus 71 Vaccine in Healthy Children
Enterovirus 71 (EV71), a cause of hand, foot, and mouth disease, may be associated with poliomyelitis-like paralysis. In this report from China, a vaccine was shown to significantly decrease EV71-associated illness in children.
Epidemics of hand, foot, and mouth disease in children have emerged recently in Asia and have been caused primarily by enterovirus 71 (EV71) and coxsackievirus A16,
1
which typically show two peak epidemic incidences each year, in May and October.
2
–
5
An important clinical concern regarding hand, foot, and mouth disease is central nervous system injury, which occurs during the disease course in some severe cases and may result in a poor outcome.
6
–
11
Infection with the EV71 C4 genotype accounts for 40.1 to 55.4% of cases of hand, foot, and mouth disease, with considerable associated mortality, including thousands of deaths . . .
Journal Article
Emergency response for recently isolated Foot and Mouth Disease virus type A Africa in Egypt 2022
Foot and mouth disease (FMD) is a highly contagious viral infection affecting cloven-hoofed ruminants, leading to significant economic losses. In 2022, Egypt faced a severe outbreak of Foot and Mouth Disease (FMD) caused by the A/Africa/G-IV variant. This study assessed the efficacy of local and imported FMDV vaccines (A Iran-05 lineage) against this new variant using in vitro and in vivo methods. Sera from vaccinated calves showed inadequate cross-protection, with mean r1-values of 0.235 and 0.243 for local and imported vaccines, respectively. Challenge tests indicated low protection levels (20% and 40%) against A/Africa/G-IV compared with A/Iran/05. Current vaccines were deemed ineffective, prompting a formulation update incorporating the variant. The modified vaccine is now deployed in proactive vaccination efforts to address the evolving FMD outbreak.
Journal Article
The pathogenesis of foot-and-mouth disease virus: current understandings and knowledge gaps
Foot-and-mouth disease (FMD) continues to be one of the most important diseases of livestock globally based upon both biological features and regulatory aspects. Few pathogens have had comparable impact on global livestock production and regulation of international trade in animal-derived products. The pathogenesis (interaction between pathogen and host) is central to the importance of the disease ranging from how the causal pathogen, FMD virus (FMDV), transmits between hosts and is maintained in populations. Key accomplishments over the last decade include description of the primary sites of infection in domestic species, delineating critical differences in temporo-anatomic progression in different host species and emphasizing that knowledge gained regarding FMDV pathogenesis in one host cannot necessarily be extrapolated and applied to a different host. Host responses to infection and viral genomics have been characterized with ever-increasing granularity. Yet, the numerous knowledge gaps that remain in understanding FMDV pathogenesis impede advancements in FMD control and eradication. For instance, it remains unclear if long-term asymptomatic FMDV carriers are biologically relevant (contagious) and the manner in which host genomics and transcriptomics affect pathogenesis during different phases of infection. The characterization of neoteric subclinical infection as a disease stage that is distinct from the persistent “FMDV carrier state” has emphasized the importance of sample collection from clinically unaffected animals for FMDV surveillance. Similarly, incorporating a phase of pre-clinical infectiousness in simulation modeling can dramatically improve prediction of FMD outbreaks in non-endemic regions. The outcome of FMDV infection with regards to viral persistence differs between host species as well as between individuals of the same species. Yet, we lack a satisfactory explanation of the host factors that drive the FMDV carrier state divergence. This review was based upon a gap-analysis workshop organized by the Global Foot-and-Mouth Disease Research Alliance (GFRA) in Buenos Aires, Argentina, in December of 2022. The purpose of this work is to summarize the current understanding of the distinct compartments of FMD pathogenesis with an emphasis on progress made within the last decade and present the critical knowledge gaps that continue to limit FMD control and eradication.
Journal Article
A Portable Reverse Transcription Recombinase Polymerase Amplification Assay for Rapid Detection of Foot-and-Mouth Disease Virus
Foot-and-mouth disease (FMD) is a trans-boundary viral disease of livestock, which causes huge economic losses and constitutes a serious infectious threat for livestock farming worldwide. Early diagnosis of FMD helps to diminish its impact by adequate outbreak management. In this study, we describe the development of a real-time reverse transcription recombinase polymerase amplification (RT-RPA) assay for the detection of FMD virus (FMDV). The FMDV RT-RPA design targeted the 3D gene of FMDV and a 260 nt molecular RNA standard was used for assay validation. The RT-RPA assay was fast (4-10 minutes) and the analytical sensitivity was determined at 1436 RNA molecules detected by probit regression analysis. The FMDV RT-RPA assay detected RNA prepared from all seven FMDV serotypes but did not detect classical swine fever virus or swine vesicular disease virus. The FMDV RT-RPA assay was used in the field during the recent FMD outbreak in Egypt. In clinical samples, reverse transcription polymerase chain reaction (RT-PCR) and RT-RPA showed a diagnostic sensitivity of 100% and 98%, respectively. In conclusion, FMDV RT-RPA was quicker and much easier to handle in the field than real-time RT-PCR. Thus RT-RPA could be easily implemented to perform diagnostics at quarantine stations or farms for rapid spot-of-infection detection.
Journal Article
Real-time decision-making during emergency disease outbreaks
In the event of a new infectious disease outbreak, mathematical and simulation models are commonly used to inform policy by evaluating which control strategies will minimize the impact of the epidemic. In the early stages of such outbreaks, substantial parameter uncertainty may limit the ability of models to provide accurate predictions, and policymakers do not have the luxury of waiting for data to alleviate this state of uncertainty. For policymakers, however, it is the selection of the optimal control intervention in the face of uncertainty, rather than accuracy of model predictions, that is the measure of success that counts. We simulate the process of real-time decision-making by fitting an epidemic model to observed, spatially-explicit, infection data at weekly intervals throughout two historical outbreaks of foot-and-mouth disease, UK in 2001 and Miyazaki, Japan in 2010, and compare forward simulations of the impact of switching to an alternative control intervention at the time point in question. These are compared to policy recommendations generated in hindsight using data from the entire outbreak, thereby comparing the best we could have done at the time with the best we could have done in retrospect. Our results show that the control policy that would have been chosen using all the data is also identified from an early stage in an outbreak using only the available data, despite high variability in projections of epidemic size. Critically, we find that it is an improved understanding of the locations of infected farms, rather than improved estimates of transmission parameters, that drives improved prediction of the relative performance of control interventions. However, the ability to estimate undetected infectious premises is a function of uncertainty in the transmission parameters. Here, we demonstrate the need for both real-time model fitting and generating projections to evaluate alternative control interventions throughout an outbreak. Our results highlight the use of using models at outbreak onset to inform policy and the importance of state-dependent interventions that adapt in response to additional information throughout an outbreak.
Journal Article
Evolutionary and structural insights into VP1 epitopes of representative SAT-type FMDV strains: implications for candidate vaccine selection
Foot-and-mouth disease (FMD) is a highly contagious viral disease primarily affecting cloven-hoofed animals, with outbreaks causing substantial economic losses. This review summarizes the global epidemiological landscape of Southern African Territories (SAT) serotypes of FMD virus (FMDV) from 2010 to May 2025, with a particular emphasis on the topotypic diversity and transboundary spread of SAT2 strains. By integrating phylogenetic analysis and epitope characterization of the VP1 capsid protein, we provide preliminary insights into the evolutionary trajectories of SAT-type FMDVs and their implications for vaccine design. In light of the challenges posed by frequent antigenic drift and poor vaccine matching, we strictly assess the current status of commercial multivalent inactivated vaccines and recent advances in empty capsid subunit vaccine technologies. Comparative evaluation of these strategies underlines the need for enhanced molecular surveillance and rational vaccine optimization to mitigate the ongoing spread of SAT-type FMDV.
Journal Article