- Title
- An investigation into ankle joint dorsiflexion, musculoskeletal injury, arch height, foot pressure and diabetes in association with poor foot health outcomes in an Aboriginal population
- Creator
- Charles, James Arthur
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2017
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Aboriginal and Torres Strait Islander Peoples suffer from high rates of chronic disease, including peripheral vascular disease, and diabetes, and the associated increases in morbidity and mortality has an enormous impact on both life span and quality of life. Foot health in Aboriginal and Torres Strait Islander Peoples is widely accepted to be poor. In those with diabetes there is a high incidence of neuropathy, foot ulceration, infection and amputation. However, there is little available literature investigating the nature and extent of foot disease in Aboriginal and Torres Strait Islander Peoples, particularly in those with diabetes, or how this can be effectively managed. Anecdotal evidence suggests high rates of restricted ankle joint dorsiflexion (ankle equinus) may exist in the Aboriginal and Torres Strait Islander population and this may be a significant contributing factor to the development of diabetic foot complications including pressure ulcerations. This research addresses the hypotheses that: ; Chronic disease and lifestyle factors significantly contribute to foot complications in Aboriginal and Torres Strait Islander Peoples. ; Culturally appropriate inclusive health promotion can improve foot health outcomes and support healthy lifestyle choices in an Aboriginal and Torres Strait Islander community. ; High prevalence of ankle equinus significantly contributes to elevated plantar pressures in Aboriginal and Torres Strait Islander Peoples with and without diabetes, which may be a significant factor contributing to poor foot health. Firstly, a literature review was conducted to establish current risk factors and risk markers for poor foot health in Aboriginal and Torres Strait Islander Peoples. Little data were found relating specifically to Aboriginal foot health, however high prevalence of chronic disease associated with foot complications including diabetes, neuropathy and peripheral vascular disease were evident. Lifestyle factors associated with increased risk of chronic disease, including smoking and obesity were also found to be highly prevalent, particularly in women. No literature investigating the role of lower limb structure or biomechanical function in development of foot complications was found. Secondly, a review of the literature to determine a reliable method of measuring ankle joint range of motion was conducted. This review showed significant inconsistency in the literature in relation to the definition and diagnosis of ankle equinus, and a lack of standardised method for clinical assessment. Based on these findings a device for accurately measuring ankle equinus was developed, (the Charles device) which was established to have excellent inter- and intra-tester reliability. Thirdly, a culturally appropriate health promotion program for improving foot health, reducing injury and increasing healthy lifestyle choices was developed for the local Worimi Aboriginal community in Forster/Tuncurry, New South Wales. Evaluation of this program demonstrated that it was effective in improving healthy lifestyle knowledge, behaviours and reducing risk of lower limb injury. These findings suggest appropriate health promotion may be successful in reducing risk of foot complications in Aboriginal and Torres Strait Islander People. Subsequently two cross-sectional cohort studies, one in Aboriginal and Torres Strait Islander People with diabetes and one in those without diabetes, were undertaken to test the hypothesis that restricted ankle joint dorsiflexion increases plantar pressures under the forefoot. High prevalence of isolated gastrocnemius equinus was found in both cohorts. Reducing ankle joint range of dorsiflexion was found to be significantly associated with higher peak pressures under the forefoot, and to be an independent predictor of increasing pressure-time integral under the forefoot in both populations. These results, limited by cross-sectional design, suggest ankle equinus may play a key role in the development of pressure-related forefoot complications in Aboriginal and Torres Strait Islander Peoples. Finally, as an appendix to this thesis, visual assessment of Aboriginal skeletal remains of the foot, of a small number of Kaurna People and 21,000 years old footprints of the Paakantji, Ngiyampaa and the Mutthi Mutthi Aboriginal People in Lake Mungo was undertaken. These were examined for arch height, indications of biomechanical characteristics of the foot and ankle and overt osseous pathology. Many of the ancient footprint showed signs of a high arch foot type similar to modern day Aboriginal footprints. In addition, bony spurring on the calcanei on a number of specimens was consistent with possible restriction in ankle dorsiflexion, suggesting ankle equinus may be an evolutionary trait in this population (Appendix 7).
- Subject
- feet; Aboriginal health; musculoskeletal injury; diabetes
- Identifier
- http://hdl.handle.net/1959.13/1353477
- Identifier
- uon:31102
- Rights
- Copyright 2017 James Arthur Charles
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 8 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 1 MB | Adobe Acrobat PDF | View Details Download |