Previously Funded Projects

APERF has supported more than 70 research projects in the past 25 years.
For a complete list of funded projects,

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Kade Paterson

Post-doctoral Fellow at the University of Melbourne and Sports
Podiatrist at Lakeside Sports Medicine Centre.

Project

A multi-faceted podiatry intervention for the management of foot osteoarthritis:
a pilot randomised controlled trial.

Osteoarthritis (OA) is a common and debilitating condition that adversely affects health, function and quality of life. The hand, knee and hip are considered to be the most commonly affected joints, however recent population statistics revealed the prevalence of foot OA is as high as knee OA. In contrast to these other joints, there are few studies on foot OA and there are no randomised controlled trials (RCT) to help guide clinical practice.

The aim of this ‘proof-of-concept’ RCT is to investigate a multi-faceted podiatry intervention in people with symptomatic foot OA compared to the usual care of analgesia advice

I received funding for a pilot randomised controlled trial (RCT) which I completed in 2018. The purpose of this pilot study was to compare a multi‐faceted podiatry intervention to general practitioner care on pain and function outcomes in people with big toe osteoarthritis. We recruited 30 people aged over 45 years with symptomatic radiographic big toe OA, and randomized them to receive either (i) one to two visits with a general practitioner, where they were given advice on their condition, self‐management and analgesic medication, or (ii) five visits with a podiatrist, where they received foot orthoses and a home exercise program. After 3 months, the results showed both groups had dramatic improvements in their foot pain and general physical function that were greater than the minimal clinically important difference. Most importantly though, I have used the feasibility and symptomatic outcome data from this APERF‐funded pilot to apply for a large NHMRC project grant.

Without the APERF funds I would never have been able to undertake the pilot trial. The grant is a great initiative for research podiatrists like myself to get some seed funding to conduct smaller projects, which ultimately increase our competitiveness for these larger grants. Hopefully this can be used to increase the evidence base for podiatry treatments.

Dr Sheree Hurn

Lecturer in Podiatry, QUT School of Clinical Sciences

Project 1

Deformity, pain and foot function in hallux abducto valgus

This project aimed to investigate the impact of hallux valgus on foot pain and lower limb function in otherwise healthy adults. Hallux valgus (more commonly referred to as ‘bunions’) is a common and progressive musculoskeletal foot deformity, affecting roughly 23% of adults aged 18 to 65 years. Comparison of 30 hallux valgus participants with 30 age and gender matched controls identified that those with hallux valgus reported significantly more foot pain, functional limitation, difficulty with footwear and concerns about the appearance of their feet. Assessment of physical function revealed weakness of muscles surrounding the big toe and impaired balance in those with hallux valgus compared to controls. These findings, published in BMC Musculoskeletal Disorders (Nix et al. 2012, 13:197), have since informed further studies investigating balance in adults with hallux valgus. Studies have linked hallux valgus to an increased risk of falls in older adults, thus these findings are important to help target clinical interventions to improve balance and muscle strength and reduce the risk of falls in this population.

Project 2

Intrinsic foot muscle activity during standing balance tasks in adults with hallux valgus compared to controls

Moderate to severe hallux valgus is associated with foot muscle weakness and impaired balance, factors which increase the risk of falls in older adults. A specific foot muscle in the arch (abductor hallucis) has been shown to be of great importance for maintaining balance during tasks of increasing difficulty, such as single leg standing. This muscle is smaller and weaker in individuals with hallux valgus, however it is unclear whether this may contribute towards poorer balance in those with moderate to severe hallux valgus. No previous studies have investigated muscle activity during balance tasks in this population. The primary aim of this study is to investigate abductor hallucis muscle activity during standing balance tasks in adults with moderate to severe hallux valgus compared to controls. A secondary aim is to explore possible associations between foot posture and mobility characteristics, toe flexor strength, abductor hallucis activity and postural sway in HV. Findings from this research will increase understanding of postural instability in adults with moderate to severe HV, specifically what foot characteristics may contribute to increased postural instability in HV. This knowledge could help target clinical interventions, such as muscle strengthening and retraining exercises, to improve balance in HV patients. This is particularly important since HV is prevalent in older adults, and falls risk is a significant health issue in this population.

Cylie Williams

Associate Professor, Allied Health Research Lead (Acute and Community Health),
Peninsula Health and NHMRC ECR Health Professional Fellow, Monash University

Project 1

Understanding sensory processing
challenges in idiopathic toe walking.

Idiopathic toe walking (ITW) can affect up to 1 in 5 children. It commonly presents to podiatrists, and there continues to be little know about why some children walk this way. At the time of funding (2010), there was little known about idiopathic toe walking, motor planning and sensory processing. The funding enable equipment purchase.

This was one of the first studies to test the sensory processing abilities and motor proficiency of children who had ITW and compared these to those of typically developing children. These were tests such as balance, strength, coordination and specific sensory tasks or parent reported behaviours to sensory stimuli. Firstly, we found that children who have ITW within this study, more likely to have poorer static and dynamic balance. We also found that children with ITW in this study were more likely to have more problems with their bilateral coordination and also upper limb coordination.

Lastly, this was the first study to use a test called the Sensory Profile with children who have ITW. We found that children in this study who also had ITW were more like to exhibit sensory seeking behaviours such as spinning and crashing into things or challenges with modulating their sensory input, such as how to adapt well to different sensory stimuli in everyday situations.

These findings have been the foundation for many other studies and grants. While we are still looking for reasons for children may exhibit ITW, we have a much better understanding on the sort of functional challenges children with ITW may have at home or when playing with their friends.

This research resulted in two publications, and was an essential component of my PhD. The findings provided a foundation for further National Health and Medical Research Council funding and international collaborations leading to better understanding this challenging cohort of children that many of us treat in clinical practice.

Project 2

Podiatrists in Australia: Investigating Graduate Employment.

We have little workforce data on podiatry, why we choose to work where we do, who we work with, what are career aspirations, when are we looking to retire and what are the factors that influence us making a decision about the type practice mix or location we work in. This two year project collected two waves of data from Victorian podiatrists, aiming to answer these questions. The first year, data were collected from over 300 podiatrists, all about them and their choices. At the same time, we undertook interviews with newly graduate podiatrists, including those who made choices to work in regional or rural settings. In our second year, we surveyed even more podiatrists about happiness, burnout, resilience and the stressors of the profession.

At the same time we interviewed regional private practice owners, peak bodies in podiatry and other allied health professions and health care services and how they recruit and retain workers. We are in the final stages of analysing much of this data with fascinating insights that will benefit our profession from an advocacy stance for the profession and government workforce information for future growth.

We hope to gain further funding in this area to expand this research into podiatry for the whole of Australia to increase the sample size, reach and particularly include podiatrists who work in rural and remote settings, particularly in Northern Territory and parts of Western Australia. This funding enabled us to test the feasibility of recruiting podiatrists in this way, how generous they were with their time and how willing they were to contributing their information as a collective. This is the sort of data that future proofs our profession and we look forward to sharing the results about this through many different avenues over the coming year.