Active Research Projects

Projects Currently Recruiting Participants:

1. Title: An evaluation of a three-dimensional foot model for studying children with flatfeet
Investigators: Angela McKenzie A, Mark Boocock, Keith Rome
Funding: AUT University
Research Co-ordinator: Mark Boocock

This project aims to use three-dimensional (3D) gait analysis to evaluate the differences in foot function of children (six – twelve years old) with normal and flatfeet.  A 3D foot model, previously used in a normal adult population, will be used to study its reliability when applied to children with flatfeet and normal feet.  The model will also test for differences in the mechanics of the foot between these two groups.

Contact: Mark Boocock

2. Title: Gout and footwear
Investigators: Keith Rome, Nicola Dalbeth, Peter McNair, Alain Vandal, Peter Gow
Funding: HRC: feasibility study

Gout displays a striking predilection to affect the feet, particularly the hallux (big toe), midfoot and ankle. Gout is major burden in New Zealand and Aotearoa New Zealand has the highest rates of disease worldwide. Poorly fitting shoes have been linked to foot pain in gout. To date, no clinical trials have addressed footwear as an intervention for patients with gout. In a recent study of footwear in patients with gout, we observed poor cushioning, lack of support, lack of stability and motion control. Based upon these findings, we concluded that footwear should be considered in the management plan of patients with gout, and future research should be focused on assessing the role of competitively priced footwear with adequate cushioning, motion control and sufficient width at the forefoot.
We are designing a randomised clinical trial on 36 patients to determine whether a specific footwear intervention can reduce foot pain and musculoskeletal disability in patients with gout.  The overall goal of this work is to identify a competitively priced shoe that is readily available in any retail store that is acceptable to patients and will address the foot problems we have previously observed in patients with gout.
Contact: Keith Rome

3. Title: Foot and ankle characteristics associated with falls and falls risk in people with rheumatoid arthritis.
Investigators: Angela Brenton-Rule, Keith Rome, Nicola Dalbeth, Hylton Menz, Sandra Bassett
Funding: Arthritis New Zealand

People with rheumatoid arthritis (RA) have an increased risk of falling. Foot deformity is common in RA and may be linked to falls. The research will assess the relationship between foot deformity and falls in people with RA. Falls can result in death, injury, loss of confidence and independence and increased risk of falling. The identification of modifiable falls risk factors, in the rheumatoid foot, may lead to the development of an intervention that prevents falls in people with RA and improves quality of life.
Contact: Angela Brenton-Rule

4. Title:
Evaluation of the Achilles tendon in gout using ultrasound and three-dimensional gait analysis.
Investigators: Matt Carroll, Keith Rome, Nicola Dalbeth, Mark Boocock
Funding: Arthritis New Zealand

Chronic gout places a significant economic burden on the health care system in New Zealand.  Chronic gout has a direct effect on the ability to work, work productivity and a reduced quality of life. There is little limited research assessing the influence of non-therapeutic factors such as biomechanical factors in chronic gout.  The mechanical efficacy of the AT could be significantly affected by tophus formation leading to significant alterations in the gait cycle function during everyday activities such as walking or participating in work.  Chronic gout is associated with the development of musculoskeletal foot pain, impairment and disability and has been linked to a reduced walking speed. Previous research has postulated that gait compensations in chronic gout may lead to reducing ankle plantarflexion creating disuse and weakness of the ankle plantarflexors.  This necessitates investigation of the relationship between impairment, clinical disease activity in the AT and gait function in chronic gout.    A better understanding of the role of AT in chronic gout may enhance our understanding of structural changes within the foot, ankle and lower limb.
Contact: Matt Carroll

5. Title: A comparison between Maori and non-Maori with diabetes of the anatomical and biomechanical parameters of the foot.
Investigators: Belinda Ihaka, Keith Rome, Wayne Hing
Funding: Podiatry New Zealand
Peripheral neuropathy is the main underlying feature in the development of foot ulcerations, although other co-founders such as limited joint mobility, increased plantar pressures, plantar fascia thickening, elevated blood glucose levels, BMI, age, footwear and ethnicity have also been postulated as risk factors to the development of foot ulceration. Previous studies have reported that the soft tissue properties of the foot may contribute to increased plantar pressures. A previous study suggested that increased thickening of the Achilles tendon and plantar fascia alters loading patterns, particularly during gait propulsion.  In another study, the authors suggest that the increased loading time during walking, was due to plantar fascial thickness. Anatomical and biomechanical parameters of the foot have not been addressed in Māori. The objective of this study is to evaluate anatomical and biomechanical parameters of the feet in Māori with diabetes. This study will be a part of future intervention studies to determine predictors of foot ulcerations to reduce the associated morbidity in Māori as a consequence. 
Contact: Belinda Ihaka

6. Title: An ultrasound investigation of the muscle characteristics of abductor hallucis in different stages of hallux valgus
Investigators: Sarah Stewart, Richard Ellis, Keith Rome
Funding: AUT University
Hallux valgus (HV), also referred to as a bunion, is a common deformity involving lateral deviation of the great toe. Crossing this joint is the abductor hallucis muscle, which has significant involvement in the pathomechanics of the deformity. The objective of the proposed study is to employ ultrasound imaging to investigate the abductor hallucis muscle characteristics, (defined as dorso-plantar thickness, medio-lateral width and cross-sectional area) in different stages of hallux valgus deformity which will be graded using the Manchester Scale. The study will involve 100 feet from participants recruited from the AUT School of Podiatry. 
Contact: Sarah Stewart

7. Title: Evaluation of a new and novel shoe insert
Investigators: Keith Rome, Peter McNair
Funding: ZIERA
From a commercial perspective, footwear, foot orthoses (FOs) and shoe inserts are commonly used to promote comfort.  Yet, the evidence to support their efficacy is not well established.  Of notable difficulty is what defines comfort.  Words such as pleasurable, sense of ease, enjoyment, well-being are often associated with the concept. These are thought to emanate from past-experiences which provide anchors for what might be perceived as either comfortable or not. In respect to comfort in shoes and shoes with FOs and inserts, one might intuitively perceive that it is related to decreasing forces and pressures, style and fit, warmth, and aesthetics.  The materials that are used in shoe construction, their amounts and their dimensions will influence these elements. Furthermore, there are likely to be anatomical and physiological parameters, such as the size and shape of a person’s foot together with its sensitivity to the materials of the shoe/FO/insert that could potentially influence the degree of perceived comfort.  It also seems likely that the interface between the foot and the insert or insole is a critical factor in determining what maximises comfort. The aim is to evaluate a new insole.

Contact: Keith Rome

8. Title: Clinical characteristics of foot ulceration in patients with chronic gout
Investigators: Keith Rome, Peter Gow, Kathryn Erikson, Anthony Ng, Hazra Hashid
Funding: New Zealand Wound Care Society
Research co-ordinator: Keith Rome
The aim of the study is to describe in depth the wound characteristics of a cohort of chronic gout patients at one participating centre. The prospective observational study will be conducted over 12 weeks. A group of 25 patients will be recruited from the rheumatology outpatient services based at CMDHB, Auckland, New Zealand. All patients will have a history of gout. All patients will have at least one foot ulcer. One examiner will conduct all the assessments at the same time point.

9. Title: The clinical and cost effectiveness of foot orthoses in the management of established rheumatoid arthritis

Investigators: Heidi Clark, John Dixon, Michael Plant, Keith Rome
Funding: University of Teesside Research Funding; Arthritis Research Campaign (UK).
Research Coordinator: Heidi Clark
The ankle and rearfoot are frequently identified as an area of the foot involved in rheumatoid arthritis (RA). To alleviate foot symptoms such as pain and to normalise the gait pattern associated with RA, health professionals commonly prescribe foot orthoses. The recent trend towards the prescription and supply of foot orthoses has resulted in many products being introduced and many more established products being used in new contexts. However, the selection and prescription of foot orthoses does not follow any set criteria, often based on consensus and opinion. Critical review of the literature has identified few well designed randomised controlled trials regarding the use of foot orthoses in the rheumatoid foot. Those identified are conflicting in their results, making clinical decision making based on current evidence difficult. Recent growing resource constraints have fostered awareness amongst clinicians of the importance of efficient practice patterns, and have sparked an interest in the methodology utilised to establish them. A few well-designed cost effectiveness analyses have been reported in the orthopaedic surgery literature. However much less is available for rheumatological disorders such as RA. The economic burden attributable to RA is not documented in the literature. However, since RA can result in considerable morbidity, there is a need to establish the most clinically and cost effective approach to the management of foot problems in RA. A gap in the literature has been identified relating to the use of foot orthoses in the established RA foot. This study proposes to address this gap by comparing two widely used types of foot orthoses in a randomised, controlled clinical trial. Participants will be blinded to the intervention. The type of foot orthoses used will be identified by surveying the current prescribing trends of health professionals working with the rheumatoid foot.   To help determine which strategy is more efficient, cost as well as effectiveness data will be collected. This crucial data will help to inform clinical decision making, building on previous work in the newly diagnosed rheumatoid foot, in that it will be supported by evidenced based guidance in order that quality standards will be raised.
Contact: Heidi Clark