Individual Foot Research Articles

The Effect of Shoe Insole Stiffness Modifications on Walking Performance in Older Adults: A Feasibility Study

Shoes or insoles embedded with carbon fiber materials to increase longitudinal stiffness have been shown to enhance running and walking performance in elite runners, and younger adults, respectively. It is unclear, however, if such stiffness modifications can translate to enhanced mobility in older adults who typically walk with greater metabolic cost of transport compared to younger adults. Here, we sought to test whether adding footwear stiffness via carbon fiber insoles could improve walking outcomes (eg, distance traveled and metabolic cost of transport) in older adults during the 6-minute walk test. 20 older adults (10 M/10 F; 75.95 [6.01] y) performed 6-minute walk tests in 3 different shoe/insole stiffnesses (low, medium, and high) and their own footwear (4 total conditions). We also evaluated participants’ toe flexor strength and passive foot compliance to identify subject-specific factors that influence performance from added shoe/insole stiffnesses. We found no significant group differences in distance traveled or net metabolic cost of transport (P ≥ .171). However, weaker toe flexors were associated with greater improvement in distance traveled between the medium and low stiffness conditions (P = .033, r = −.478), indicating that individual foot characteristics may help identify potential candidates for interventions involving footwear stiffness modifications.

Factors associated with the development of recurrent and contralateral Charcot neuroarthropathy in individuals with diabetes mellitus: A scoping review.

Charcot neuroarthropathy (CN) can result in fractures and dislocations of the foot and ankle in individuals with diabetes and neuropathy, leading to ulceration, amputation and a poor quality of life. Additional episodes of acute CN can lead to extended periods of physical and psychosocial distress. The aim of this scoping review was to identify and synthesise the evidence relating to factors associated with the development of recurrent and contralateral Charcot neuroarthropathy (CN) in individuals with diabetes. A systematic search of four electronic databases was conducted from inception to February 06, 2023. All relevant study designs, except single case studies, that had been published in full in peer-reviewed journals were included. Studies were excluded if they were not published in English and did not provide data on individuals with diabetes. The search identified two studies that investigated factors associated with the development of recurrent CN, but none that related to the development of contralateral CN. Ten factors were investigated for association with recurrent CN development: age, body mass index, diabetes type and duration, glycated haemoglobin, anatomical site affected, duration of offloading applied to treat the primary CN episode, use of pharmacological intervention, severity of neuropathy, and skin temperature. However, no significant associations were reported. There is an alarming lack of evidence-based findings in this research area to guide practice. Clearly, more research in the form of rigorous prospective studies is urgently required to identify risk factors for the development of recurrent and contralateral CN in individuals with diabetes.

Modern trends in the study of the condition of the human foot: an analysis of scientific and methodological literature

The study of the structure and functions of the human foot at various stages of ontogenesis is the basis for the timely detection of its disorders and the implementation of a system of corrective and preventive measures. The systematization of existing experience will help clarify the range of unresolved issues in this scientific field. The aim of the work is to analyze modern trends in the study of the condition of the feet of individuals of different ages based on data from scientific and methodological literature. Research methods: the method of analyzing scientific and methodological literature, systematization, and generalization. Research results: modern directions in the study of the human foot have different methodological foundations for research. Alongside methods of operational control of the structure and functions of the foot, which are based on widely accessible research methods, modern hardware and software are increasingly being used to implement forms of in-depth control. Among researchers, comprehensive diagnostic systems have gained popularity, allowing for the assessment of the structure and functions of the foot in both static and dynamic measurements (in a stationary state and during the performance of movement activities).

Phytochemical Potential of Maggot Extract Antimicrobial for Escherichia Colisp. in Diabetic Ulcers of Diabetes Mellitus II

Diabetes Mellitus (DM) is a metabolic disorder related to the relative deficiency of insulin secretion, affecting the metabolism of carbohydrates, fats, and proteins, leading to chronic hyperglycemia caused by genetic and environmental factors. This condition significantly impacts the quality of life, primarily due to complications such as diabetic ulcers. Diabetic foot ulcers are non-traumatic lesions on the skin of the foot in individuals with diabetes mellitus, resulting from repeated pressure and associated diabetes complications related to peripheral neuropathy. The healing of wounds can be facilitated through Maggot Debridement Therapy, a treatment involving the application of maggots or larvae of the Black Soldier Fly (BSF). These maggots secrete enzymes that dissolve necrotic tissue, disinfect the wound, and stimulate wound healing. This study aims to analyze the effectiveness of methanol extract from Maggot (H. illucens) in inhibiting the migration of bacterial cultures and its potential as an antimicrobial agent against bacteria found in diabetic foot ulcers (DM II). The maggot was extracted using the maceration method with methanol, and its content was determined through phytochemical and GC-MS tests. The antibacterial test was conducted using E. coli. Phytochemical testing revealed that the methanol extract of maggot contains saponin, as evidenced by the formation of foam after the addition of distilled water and agitation. The results of the antibacterial test indicated that the methanol extract of Maggot (Hermetia illucens) can inhibit the growth of Escherichia coli bacteria concentration of 12,5%.

Risk factors for Charcot foot development in individuals with diabetes mellitus

Aims/hypothesisCharcot foot is a complication of diabetes mellitus that has potentially disastrous consequences. Although it was first described in 1868 and found to be associated with diabetes in 1936, there is still uncertainty about the risk factors affecting the development of the condition. Here, we aim to identify risk factors for Charcot foot in a nationwide cohort study.MethodsA retrospective register-based cohort study was performed for the period 2001–2016, using nationwide registries. Individuals with diabetes and Charcot foot were identified and matched by diabetes type and with similar diabetes duration with individuals with diabetes but not Charcot foot. Logistic regression analyses were used to identify risk factors.ResultsA total of 3397 participants with diabetes mellitus and Charcot foot and 27,662 control participants with diabetes but without Charcot foot were included. HbA1c, duration of diabetes, micro- and macroalbuminuria, retinopathy and atherosclerosis (general and peripheral) were identified as risk factors for Charcot foot in participants with type 1 diabetes and participants with type 2 diabetes.Conclusions/interpretationIn the most extensive study on Charcot foot to date, we identified distinctive and common risk factors associated with the development of Charcot foot in individuals with type 1 diabetes and type 2 diabetes.Graphical

Differences in the Size of Individual Plantar Intrinsic Foot Muscles Between Ballet Dancers and Non-Dancers.

In classic ballet, choreography often involves tiptoe standing. Tiptoe standing requires a high and stable foot arch structure, which is achieved by contraction of the plantar intrinsic foot muscles (PIFMs). Long-term repetitive loading with a specific movement can induce hypertrophic adaptation of the associated muscles. For dancers, however, limited information on the size of individual PIFMs is available from previous studies. The purpose of this study was to determine the differences in the sizes of 10 individual PIFMs between dancers and non-dancers. Muscle volumes (MVs) of 10 individual PIFMs were measured using magnetic resonance imaging in 15 female dancers and 15 female non-dancers. Muscles analyzed included abductor hallucis, flexor digitorum brevis, abductor digiti minimi, quadratus plantae, lumbricals, flexor hallucis brevis, adductor hallucis oblique head, adductor hallucis transverse head, flexor digiti minimi, plantar/dorsal interossei. In addition to absolute MVs, relative MVs normalized to body mass (rMVBM) and the percentage of individual MVs relative to the sum of 10 individual PIFM MVs (%MVWHOLE) were calculated. The absolute MVs of 6 individual PIFMs, including the flexor digitorum brevis and lumbricals, were +16% to 59% larger in dancers than in non-dancers (P ≤ .048). The rMVBM of all individual PIFMs were +35% to 95% larger in dancers than in non-dancers (P ≤ .019). The %MVWHOLE of the flexor digitorum brevis and lumbricals were +10% to 36% higher (P ≤ .014) and those of the abductor digiti minimi and adductor hallucis oblique head were +8% to 11% lower (P ≤ .037) in dancers than in non-dancers. For all 3 MV measures, only the flexor digitorum brevis and lumbricals, which are functionally specialized for flexion of the second to fifth metatarsophalangeal joints, were consistently larger in dancers than in non-dancers. This may be due to long-term repetitive loading on these PIFMs during ballet training involving tiptoe standing.

Footedness in merlins: Raptors perching in a cold climate

ABSTRACT Perching or standing on one foot is commonly reported in birds but the level of consistency in using one foot over the other has been less-well documented in most species, particularly birds of prey. For birds experiencing colder temperatures, unipedal perching has been attributed to limiting heat loss through unfeathered legs and feet; individuals should spend longer periods of time perched on one foot as temperatures decrease. Using radio tracking, I collected 486 hours of observations on nine overwintering, free-living merlins (Falco columbarius) in Saskatoon, Canada. Five merlins displayed clear preferences to perch on one foot, however the direction of preference was not consistent and four birds were ambidextrous. There was a curvilinear response in the proportion of time spent in unipedal posture versus temperature, with a peak of ∼22% of the time at moderate temperatures (−10 to −19°C), but lower values at warmer and colder temperatures; the main effect of the squared term for temperature was highly influential while individual foot preference had no impact on the use of unipedal perching. Although preferential use of one foot for perching was displayed by some individuals, thermoregulation may not be the primary driver of this behaviour at colder temperatures.

A Preliminary Study on the Effects of 4-Week Training Program with Interactive Floor Support on Plantar Pressure Distribution in Sedentary Individuals

Objective: Our purpose was to investigate on the effects of foot exercises by using interactive floor support as a modality of rehabilitation technology on plantar pressure distribution in sedentary individuals. Methods: Participants who were aged between 18-35, who agreed to participate voluntarily and had no pathology developed in the lower extremities in the past 6 months were included in this study. In order to determine the plantar pressure distribution change of all participants, the first and last evaluation was measured with Emed® Pedobarography. Balance and proprioception exercises on both lower extremities for 12 sessions (for four weeks, three sessions per week, lasts 15 minutes each) were performed with an interactive floor device. Results: A total of 15 healthy and sedentary subjects (12 female, 3 male, with a mean of 20,27±0,961 years and 21,31 ± 3,027 kg/m2 BMI) completed the four-week training protocol. Maximum force of total and hindfoot in both feet significantly decreased after 4-week training (p.05). Conclusion: Based on our results, the present study revealed that the 4-week training programme with interactive floor support for ankle joint could decrease maximum force of total and hindfoot on the bottom of the dominant and non-dominant side feet in healthy and sedentary individuals. Future investigation should be conducted to clarify the effects of long-term training programs with interactive floor support on plantar pressure distribution in patients with foot deformities.

A dynamic foot model for predictive simulations of human gait reveals causal relations between foot structure and whole-body mechanics.

The unique structure of the human foot is seen as a crucial adaptation for bipedalism. The foot's arched shape enables stiffening the foot to withstand high loads when pushing off, without compromising foot flexibility. Experimental studies demonstrated that manipulating foot stiffness has considerable effects on gait. In clinical practice, altered foot structure is associated with pathological gait. Yet, experimentally manipulating individual foot properties (e.g. arch height or tendon and ligament stiffness) is hard and therefore our understanding of how foot structure influences gait mechanics is still limited. Predictive simulations are a powerful tool to explore causal relationships between musculoskeletal properties and whole-body gait. However, musculoskeletal models used in three-dimensional predictive simulations assume a rigid foot arch, limiting their use for studying how foot structure influences three-dimensional gait mechanics. Here, we developed a four-segment foot model with a longitudinal arch for use in predictive simulations. We identified three properties of the ankle-foot complex that are important to capture ankle and knee kinematics, soleus activation, and ankle power of healthy adults: (1) compliant Achilles tendon, (2) stiff heel pad, (3) the ability to stiffen the foot. The latter requires sufficient arch height and contributions of plantar fascia, and intrinsic and extrinsic foot muscles. A reduced ability to stiffen the foot results in walking patterns with reduced push-off power. Simulations based on our model also captured the effects of walking with anaesthetised intrinsic foot muscles or an insole limiting arch compression. The ability to reproduce these different experiments indicates that our foot model captures the main mechanical properties of the foot. The presented four-segment foot model is a potentially powerful tool to study the relationship between foot properties and gait mechanics and energetics in health and disease.

Ultrasound Evaluation of Achilles Tendon Thickness in Diabetic Patients With and Without Foot Complications.

Introduction Diabetes mellitus (DM) is a multifaceted metabolic disorder distinguished by elevated blood sugar levels. Type 2-DM (T2DM) stands as a significant contributor to disability due to its widespread occurrence of microvascular and macrovascular complications. According to certain researchers, prolonged elevated blood sugar levels have been observed to trigger a sequence of irregular alterations in the Achilles tendon (AT). AT thickness is one such indicator of these alterations. Methods This was a prospective study carried out on 51 individuals which was further divided into 3 groups (Group A - Normal individuals, Group B - DM without foot complications, Group C - DM with foot complications) with 17 individuals in each as healthy, DM with foot complications and without complications at Sri Devaraj Urs Medical College over a period of one year. The patients' demographics, basic medical records, and laboratory test results were examined and analyzed. Results The mean age of the study participants was 55.41 + 10.25 years. There was no significant difference in age and gender between the three groups. There was a significant difference in mean AT thickness between the groups (p<0.05). The mean thickness of AT was higher in Group C compared to Group B. Group A had the least AT thickness. However, there was no correlation between the variables in individual groups. Conclusions Modifications in the AT's structure may occur before the onset of foot and ankle issues in individuals with diabetes. Hence, the thickening of the AT can be used as an early indicator of impending diabetic foot complications.

Design of integral backstepping controller - sliding mode along with admittance controller of knee joint robot in the presence of noise

Robots are increasingly being used in rehabilitation to assist patients with physical disabilities, particularly the knee joint. Physiotherapists often practice the patient’s leg around the knee joint to strengthen the muscles. However, Continuous Passive Motion (CPM) devices face challenges such as lack of feedback and resistance. This thesis aims to address these issues by using admittance and impedance concepts to control the robot’s flexible behavior against individual foot forces. The research uses a combination of backstepping and admittance algorithms, Model Reference Adaptive Control (MRAC), Sliding-Backstepping and Admittance Control to create a soft interactive patient-robot interaction. The device is designed for both left and right legs.

Extracorporeal Shock Wave Therapy with Low-Energy Flux Density Treatment Applied to Hemiplegia Patients on Somatosensory Functions and Spatiotemporal Parameters.

We aimed to investigate the efect of Extracorporeal Shock Wave Therapy (ESWT) applied to patients with hemiplegia on somatosensory data, spatiotemporal parameters, posture, and muscle tone. This was a double-blind, randomised, controlled trial. Patients were randomised within pairs to either the experimental (ESWT) group (n=20) or the control group (n=20). All patients participated in the same conventional stroke rehabilitation program for 60 minutes of treatment a day, 5 times a week for 6 weeks (30 sessions). Patients assigned to the ESWT group received additional ESWT over the plantar fascia 3 days/week for 6 weeks. Timed Up and Go (TUG) test, Modified Ashworth Scale (MAS) score, Posture Assessment Scale for Stroke Patients (PASS), spatiotemporal parameters, Semmes-Weinstein monofilament (SWM) test, and vibration sensation test (VST) were performed in all participant before and after treatment. In the ESWT and control groups, statistically, significant diferences were obtained in the posttreatment analysis than pre-treatment. Significant diferences were found in foot angle, step cycle duration, swing phase, cadence, gait cycle distance, and VST values after ESWT treatment (P < .01). When combined with a neurological rehabilitation program, it was determined that ESWT applied to the plantar face of the foot in individuals with hemiplegia increased somatosensory functions and was more successful in developing postural control and balance.

Repeatability of [15O]H2O PET imaging for lower extremity skeletal muscle perfusion: a test–retest study

Background[15O]H2O PET/CT allows noninvasive quantification of tissue perfusion and can potentially play a future role in the diagnosis and treatment of peripheral artery disease. We aimed to evaluate the reliability of dynamic [15O]H2O PET imaging for measuring lower extremity skeletal muscle perfusion. Ten healthy participants underwent same-day test–retest study with six dynamic [15O]H2O PET scans of lower legs and feet. Manual volume-of-interests were drawn in skeletal muscles, and PET time activity curves were extracted. K1 values (mL/min/100 mL) were estimated using a single-tissue compartment model (1TCM), autoradiography (ARG), and parametric imaging with blood input functions obtained from separate heart scans.ResultsResting perfusion values in the muscle groups of the lower legs ranged from 1.18 to 5.38 mL/min/100 mL (ARG method). In the muscle groups of the feet, perfusion values ranged from 0.41 to 3.41 mL/min/100 mL (ARG method). Test–retest scans demonstrated a strong correlation and good repeatability for skeletal muscle perfusion with an intraclass correlation coefficient (ICC) of 0.88 and 0.87 and a repeatability coefficient of 34% and 53% for lower legs and feet, respectively. An excellent correlation was demonstrated when comparing volume-of-interest-based methods (1TCM and ARG) (lower legs: ICC = 0.96, feet: ICC = 0.99). Parametric images were in excellent agreement with the volume-of-interest-based ARG method (lower legs: ICC = 0.97, feet: ICC = 0.98).ConclusionParametric images and volume-of-interest-based methods demonstrated comparable resting perfusion values in the lower legs and feet of healthy individuals. The largest variation was seen between individuals, whereas a smaller variation was seen between muscle groups. Repeated measurements of resting blood flow yielded a strong overall correlation for all methods.

Novel Vibrating Foot Orthoses for Improving Tactile Sensation in Type 2 Diabetes With Peripheral Neuropathy.

Improving tactile sensation by vibrating insoles was recommended to prevent foot ulcers in diabetic peripheral neuropathy (DPN). Lack of an insole design for diabetics was a challenge. Clinical trials on applying vibrating insoles with noise and stochastic resonance (SR) stimulating tactile were also required. In this study, vibrating foot orthoses (VFO) with a total contact design based on orthotics were proposed to provide proper insoles for diabetes. This study aimed to determine if VFO were beneficial at enhancing tactile in DPN. VFO were developed in combination with individual's custom-made foot orthoses and stimulation signals-integrating random 0-100 Hz square wave pulse signals with pseudorandom white noise by a SR approach. Sixty patients with mild-to-severe DPN were randomized to conduct crossover experiments: using and without VFO for 60 minutes stimulation at 90% of individuals' vibration perception threshold (VPT) level. VPT values when using VFO at the 1st and 5th metatarsophalangeal joints of the left foot decreased by 9.35% ( [Formula: see text].001); 9.04% ( [Formula: see text].001), and of the right foot decreased by 7.63% ( [Formula: see text].001); 7.24% ( [Formula: see text].001), respectively. Without VFO, there was no significant difference. Subgroups of mild and moderate DPN tended to benefit greatly from utilizing VFO. VFO can improve tactile in DPN. VFO may contribute to restoring/prolonging tactile and protective sensations, also decreasing peripheral nervous system deterioration. VFO might be useful for neurorehabilitation, and help prevent foot ulcers and disabilities.

Tax Boycotts

ABSTRACT To what extent do U.S. consumers change their purchase behavior or, in the extreme, boycott companies based on negative information about corporate tax activities? Practitioner publications and academic research identify consumers as a key corporate tax stakeholder. But we have limited empirical evidence whether information about corporate tax activities influences consumer actions. We undertake a comprehensive study of this question, triangulating across several settings. First, a representative sample of consumers suggests they rarely boycott in response to corporate tax activities. Next, an analysis of granular retail scanner data fails to provide compelling evidence of consumer purchase responses to negative tax news. An analysis of individual foot traffic at retail establishments around negative tax news again fails to suggest U.S. consumers change their shopping activities in response to negative tax news. The combined evidence suggests consumers do not meaningfully alter their purchase behavior in response to negative tax news. JEL Classifications: M41; M48; H25; H26.

FMRI changes during multi-limb movements in Parkinson's disease.

BackgroundWhile motor coordination problems are frequently reported among individuals with Parkinson’s disease (PD), the effects of the disease on the performance of multi-limb movements and the brain changes underlying impaired coordination are not well-documented.ObjectiveFunctional magnetic resonance imaging (fMRI) was used to examine differences in brain activity during a task that involved the coordination of non-homologous limbs (i.e., ipsilateral hand and foot) in individuals with and without PD.MethodsParticipants included 20 PD and 20 healthy control participants (HC). They were instructed to generate force in a coordinated manner by simultaneously contracting their ipsilateral hand and foot. PD were tested off their antiparkinsonian medication and on their more affected side, whereas the side in controls was randomized.ResultsAlthough both groups were able to coordinate the two limbs to produce the expected level of force, PD had a slower rate of force production and relaxation compared to HC. Additionally, their globus pallidus and primary motor cortex were underactive, whereas their pre-supplementary motor area (pre-SMA) and lateral cerebellum were overactive relative to HC. Importantly, in PD, the fMRI activity within the pre-SMA correlated with the rate of force decrease.ConclusionMulti-limb force control deficits in PD appear to be related to widespread underactivation within the basal ganglia-cortical loop. An overactivation of higher-level motor regions within the prefrontal cortex and lateral cerebellum may reflect increased cognitive control and performance monitoring that emerges during more complex motor tasks such as those that involve the coordination of multiple limbs.

Augmented Smart Insoles – Prototyping a Mobile Application: Usage Preferences of Healthcare Professionals and People with Foot Deformities

Abstract The augmentation of smart insoles gained increased interest due to the possibilities in foot-related rehabilitation, medical treatment, and postural risk prevention. As shown by previous work, the technology offers a personalized solution for individual foot morphology and biomechanics, which can monitor the health status and healing process. However, the success of this mobile technology depends on its usability and acceptance by healthcare professionals and patients. Therefore, an exploratory qualitative user study was conducted to investigate the preferences of healthcare professionals and patients regarding augmented smart insoles (ASI) usage. In focus groups, experts and patients explored their needs and suggested potential design solutions. The thematic analysis of the participants’ feedback revealed useful information regarding user interface (UI) designs for the development of a mobile application supporting smart insoles. We found that patients and experts share similar data preferences for a mobile application supporting ASI and that both user groups desired the presence of complete pressure point monitoring, active feedback for posture correction, and personalized training videos for postural risk prevention. However, healthcare professionals expressed concerns regarding the lack of scientific evidence validating the effectiveness of this technology and suggested further research.

A fact-finding survey on pre-ulcerative lesions of foot in patients with diabetes: analysis using the Diabetes Study from the Center of Tokyo Women's Medical University 2018 (DIACET 2018).

We aimed to identify the frequency and risk factors of pre-ulcerative lesions of foot in Japanese individuals with diabetes. This was a single-center cross-sectional observational study. We conducted a questionnaire survey of 5029 individuals with diabetes (mean age 63years; 2185 women; 1015 individuals with type 1 diabetes and 4014 individuals with type 2 diabetes) who (a) participated in the Diabetes Study from the Center of Tokyo Women's Medical University: DIACET 2018, and (b) responded to the presence of pre-ulcerative lesions of foot. A pre-ulcerative lesions of foot was defined as a calluses, ingrown nails, or symptoms of fungal infection. The associations between pre-ulcerative lesions of foot and commonly available clinical information were examined using the logistic regression analysis. 412 of 1015 (40.6%) individuals with type 1 diabetes and 1585 of 4014 (39.5%) individuals with type 2 diabetes reported having any type of pre-ulcerative lesions of foot. The frequency of calluses, ingrown nails, and symptoms of fungal infection, respectively, were 16.8%, 15.8%, and 21.9% in type 1 diabetes and 10.5%, 18.5%, and 24.7% in type 2 diabetes. In the separate analysis by type of diabetes, common risk factors found to be significantly correlated with pre-ulcerative lesions of foot were female gender, numbness in the feet and foot deformation. Proactive foot screening by health care professionals was considered important, especially in individuals with type 1 and type 2 diabetes with advanced complications and foot deformation. The online version contains supplementary material available at 10.1007/s13340-023-00649-7.

MSA-based seismic fragility analysis of RC structures considering soil nonlinearity effects and time histories compatible to uniform hazard spectra

In the present study, an updated ground motion simulation framework based on spectral compatible time histories is proposed for the evaluation of seismic performance of mid-rise reinforced concrete structures with multi-stripe analysis (MSA) based probabilistic seismic hazard analysis. The seismic fragility functions are generated for two numbers of three storied instrumented test buildings of which one is founded on individual flexible footings and other one is a base isolated building. The fragility analysis is carried out for different performance levels under a series of input ground motions (IGMs) by considering uncertainty in soil structure interaction and uncertainty in ground motion. IGMs are obtained from the uniform hazard response spectrum (UHRS) with different return period thus conserving the frequency content of input motion during the scaling of high intensity earthquakes. The UHRS compatible synthetic time histories are applied at rock level and amplified surface motion obtained from soil amplification studies considering soil nonlinearity are applied to the buildings supported on soil springs. Nonlinear time history analysis is performed by modelling hysteretic characteristic of columns using modified Takeda model. The fragility curves obtained from the proposed methodology are compared with that using simple scaling of accelerograms generally performed in literature. The proposed technique gives conservative result for structure with individual flexible footings while no marked differences are observed for base isolated structure.

Association between effect of acceptance of illness and medication adherence, metabolic control, and risk of diabetic foot in individuals with diabetes

AimsThis study aimed to determine the association between the level of acceptance of illness and medication adherence, metabolic control, and risk of diabetic foot in patients with diabetes. MethodsThis descriptive study was conducted with 298 patients with diabetes. The questionnaire comprised the demographic characteristics of the patients, Modified Morisky Scale and the Acceptance of Illness Scale. The study data were collected by the researchers through direct interviews using the questionnaire. ResultsAcceptance of illness in patients with diabetes was statistically significantly higher in the group with a higher level of knowledge of medication adherence (p < 0.001). Moreover, the acceptance of illness had a statistically significant negative correlation with fasting plasma glucose (r = −0.198; p < 0.001) and glycated hemoglobin (r = −0.159; p = 0.006) levels in individuals with diabetes. Levels of acceptance of illness had a statistically significant association with the risk of diabetic foot (p < 0.01). ConclusionsThe study found that the level of acceptance of illness was associated with the level of knowledge about medication adherence, metabolic control, and risk of diabetic foot in individuals with diabetes. It may be recommended to conduct clinical trials to determine the effect of evaluating the level of acceptance of the illness on diabetes management and to increase this level.