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Transcultural Adaptation and Validation of the Spanish Version of the Visual Analogue Scale for the Foot and Ankle (VASFA)

2026-09-07T12:23:34Z

Título : Transcultural Adaptation and Validation of the Spanish Version of the Visual Analogue Scale for the Foot and Ankle (VASFA) Autor : Cervera Garvi, Pablo; Galán Hurtado, María Hermas; Marchena-Rodriguez, Ana; Chicharro-Luna, Esther; Guerra Marmolejo, Cristina; Diaz-Miguel, Salvador; Ortega-Avila, Ana Belen Resumen : The main aim of this study is to perform a cross-cultural adaptation and validation of the Visual Analogue Scale for the Foot and Ankle (VASFA) questionnaire, creating a Spanish-language version (VASFA-Sp), and to determine the measurement properties of this instru-ment. Methods: VASFA was cross-culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The study sample was composed of 228 participants who were recruited from February to May 2022. All were at least 18 years old, gave signed informed consent to take part and properly completed the Foot and Ankle Ability Measures-Sp and VASFA-Sp questionnaires. Cronbach’s alpha and test/re-test reliability val-ues were calculated. Structural validity was assessed via exploratory factor analysis. Results: The 228 patients included in the ﬁnal analysis presented the following characteristics: 35.53% were male and 64.47% were female; the mean age was 35.95 (18–81) years; and the mean body mass index was 23.79. Internal consistency was excellent. The Cronbach’s alpha for VASFA-Sp was 0.96 and the in-traclass correlation coeﬃcient was 0.932 (95% CI; 0.84 to 0.97). Exploratory factor analysis identiﬁed one main factor. Conclusions: VASFA-Sp is a reliable, valid and sensitive questionnaire that is suit-able for measuring perceived foot and ankle function impairment in a Spanish-speaking population.

The influence of sock composition on the appearance of foot blisters in hikers

2026-09-07T12:22:44Z

Título : The influence of sock composition on the appearance of foot blisters in hikers Autor : Chicharro-Luna, Esther; Gijon-Nogueron, Gabriel; Sanchez Rodriguez, Raquel; Martínez Nova, Alfonso Resumen : Introduction: Socks are of fundamental importance in reducing friction and in controlling the temperature and humidity of the foot, thus preventing the appearance of blisters. However, the influence of sock fibres (synthetic vs. natural) on blistering during long-distance hiking has received little research attention. Aims: This study evaluates the influence of sock fibres on the appearance of foot blisters in hikers. Method: The sample consisted of 203 male and female hikers, mean age 35.8 ± 14.5 years, from 22 countries. All were interviewed and assessed at shelters on the French route of the Camino de Santiago (Spain). Sociodemo-graphic and clinical data were obtained for each hiker; other study data included the number of blisters on the foot, whether the socks were wet at the end of the day, the model of sock used and the nature of its constituent fibres. Results: Among the hikers interviewed, 68.5% presented foot blisters. 74.2% used socks with predominantly synthetic fibres, compared to 25.9% whose socks were mainly composed of natural fibres. On average, they had walked 253.7 km. Hiking in wet socks was associated with a 1.94 times greater risk of experiencing foot blisters (95% CI 1.04–3.61) (p = 0.035). Multivariate analysis showed that the proportion of natural/synthetic fibres in the composition of the sock was not related to the presence of blisters. Conclusions: The use of wet socks heightens the risk of foot blisters in hikers, but the composition of the sock is not associated with blistering. We recommend hikers change their socks in long stages to maintain feet dry and so avoiding the appereance of blisters.

Fit for purpose? Footwear for patients with and without diabetic peripheral neuropathy: A cross-sectional study

2026-09-07T12:21:25Z

Título : Fit for purpose? Footwear for patients with and without diabetic peripheral neuropathy: A cross-sectional study Autor : Chicharro-Luna, Esther; Ortega-Avila, Ana Belen; Requena-Martínez, Aranzazu; Gijon-Nogueron, Gabriel Resumen : Aim: This paper determines whether patients with and without Diabetic Peripheral Neuropathy use suitable footwear, taking into account that these persons are subject to a significant loss of sensitivity in the feet. Methods: Cross-sectional observational study was conducted of 108 participants with diabetes mellitus. Inclusion criteria were at least five years’ progression of diabetes, the ability to walk unaided and no distal amputation of the foot. The presence of DPN was evaluated according to the criteria of the International Working Group on the Diabetic Foot. Foot length was measured using a Brannock® device and internal shoe length was determined using a CEGI® pedometer. Results: In relation to adjustment, 21.6% of the shoes examined had no type of closure. The most common form of closure was laces, which were used in 32.4% of the shoes. 92.5% of footwear had internal seams. No significant relationship was found between the presence or otherwise of DPN and the use of appropriate shoe closure (p = 0.304), recommended heel height (p = 0.18), leather material (p = 0.77) and absence of internal seams (p = 0.759). Conclusions: The majority of our participants living with DPN do not wear fitting shoes. Therefore, it is advisable to evaluate their use of footwear, both in primary health care and in podiatry clinics, to forestall potential complications.

Update of Modified Version of the Foot Function Index Tool Spanish Version (FFI-Sp), in Patients with Rheumatoid Arthritis: Cross Sectional Study

2026-09-07T12:30:11Z

Título : Update of Modified Version of the Foot Function Index Tool Spanish Version (FFI-Sp), in Patients with Rheumatoid Arthritis: Cross Sectional Study Autor : Gámez Guijarro, María; Reinoso Cobo, Andrés; Gordillo Fernández, Luis María; Ortiz Romero, Mercedes; Ortega-Avila, Ana Belen; Chicharro Luna, Esther; Gijon-Nogueron, Gabriel; Lopezosa-Reca, Eva Resumen : Background and Objectives: The Foot Function Index (FFI) is a widely recognized patient-reported outcome measure (PROM) for assessing foot functionality and its impact on quality of life in individuals with rheumatoid arthritis (RA). This study aimed to observe the behavior of the tool in the Spanish population with RA, optimize the tool, and check its functionality. Materials and Methods: A total of 549 RA patients, with a predominant female participation (75.6%). This study involved a comprehensive statistical analysis, leading to a refined version of the FFI for a Spanish-speaking population. Results: The original 23-item FFI was revised, resulting in a 15-item version by excluding items that caused confusion or were considered redundant. This modified version maintained the original's subscales of pain, disability, and activity limitation, but with an adjusted item distribution. The construct validity was confirmed through exploratory factor analysis, demonstrating excellent fit indices (Kaiser-Meyer-Olkin test = 0.926, Bartlett's test of sphericity = 4123.48, p < 0.001). The revised FFI demonstrated good internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (ICC = 0.89). Conclusions: This study highlights the applicability of the FFI in Spanish-speaking RA populations, offering a valid and reliable tool for clinicians and researchers. The modifications enhance the FFI's relevance for RA patients, facilitating better assessment and management of foot-related functional impairments.

Correlation between the foot pressure index and the prevalence of plantar hyperkeratosis

2026-09-07T12:19:18Z

Título : Correlation between the foot pressure index and the prevalence of plantar hyperkeratosis Autor : Sánchez-Rodríguez, Raquel; Martínez-Quintana, Rodrigo; Martínez Nova, Alfonso; Martínez-Rico, Magdalena; Pedrera-Zamorano, Juan Diego; Chicharro-Luna, Esther Resumen : Plantar hyperkeratosis (HK) is a very prevalent foot lesion formed due to an alteration in the keratinisation process, thereby increasing keratynocites and accumulating multiple layers of the stratum corneum that leads to plantar pain. As foot shape and plantar pressures is related with their appearance, the aim of this study is to examine how foot posture and plantar pressure influence the appearance of this keratopathy. Material and methods: On a sample of 400 subjects (201 men and 199 women), the plantar pressures were evaluated by the Footscan® platform in 10 zones. The clinical exploration consisted in the valuation of the Foot Posture Index (FPI), and the assessment of the appeerance (and location) or not of plantar calluses or hyperkeratosis. Results: 6.3% of the feet presented a highly supinated FPI, 15.5% were supinated, 57.3% corresponded to neutral, 17.3% were pronated and 3.8% were highly pronated. The participants with HK on the hallux, on the 1st, 2nd, 3rd or 5th MTH or on the lateral heel had a significantly higher pressure index (p < 0.001), ranging from 24.3 to 44% higher than those with no such alteration. Of the highly pronated feet, 66.7% presented HK in the hallux, while 32.3% of the supinated feet and 60% of the highly supinated feet presented it beneath the first MTH. Conclusion: Foot posture influences the appearance of HK, though its association with plantar pressures. The participants with HK presented a mean foot pressure that was 32.3% higher than in those with no such condition. These values can be considered predictive for the appearance of HK and should be indicative of the need for preventive treatment.

Impact of foot functionality in patients with systemic sclerosis: Cross-sectional study.

2026-09-07T12:18:30Z

Título : Impact of foot functionality in patients with systemic sclerosis: Cross-sectional study. Autor : Chicharro-Luna, Esther; Gracia-Vesga, Miguel Ángel; Ramos-Petersen, Laura; Gijon-Nogueron, Gabriel Resumen : BACKGROUND: Progressive systemic sclerosis or systemic scleroderma (SS) is a chronic and rare autoimmune disease that mainly affects the skin and various internal organs. Raynaud's phenomenon and digital ulcers are some of the symptoms that affect the foot, causing a decrease in the quality of life of patients. The objective of this study is to determine the functionality of the feet in patients with SS and determine the impact on their daily lives. METHODS: A sample of 165 patients (154 women, 11 men) diagnosed with SS with a mean age of 46.29 ± 11.36 years and a mean body mass index (BMI) of 24.90 ± 5.77 was recruited. Each participant completed the Foot Function Index (FFI) questionnaire and the Systemic Sclerosis Questionnaire (SySQ). A multivariate analysis was performed to determine which factors were related to a higher score in both questionnaires. RESULTS: 32.1% of the participants (n = 53) had claw toe deformities, 79.4% (n = 131) Raynaud's disease and 20% (n = 33) a history of foot ulcers. 51.5% of the participants (n = 85) presented symptoms in their nails, the most frequent sign being thickening, hardening and yellow coloration. The final score of the FFI questionnaire was 3.51 ± 2.41 (0-9.9), the pain subscale being the highest, with a score of 5.06 ± 2.75, followed by foot disability (3.26 ± 2.91) and difficulty performing activities (1.55 ± 2.22). The final score of the SySQ questionnaire was 0.95 ± 0.45 (0.18-2.45), and the subscales with the highest score were symptom frequency (1.30 ± 0.47), symptom intensity (1.11 ± 0.55), and general skill limitation (0.47 ± 0.51). A high correlation was observed between the final FFI score and the final SySQ score (r = 0.712; p=<0.001). Also, between foot activity limitation and general skill limitation (r = 0.658; p=<0.001). A moderate correlation was observed between foot pain score and overall symptom intensity (r = 0.482; p=<0.001). Also, between foot disability and overall symptom frequency (r = 0.556; p=<0.001). The multivariate analysis (R2 0.51) showed that the final FFI score had a significant relationship with the final SySQ score (p < 0.001). No significant correlation was found between age (p = 0.15), gender (p = 0.49), BMI (p = 0.74) or time of diagnosis (p = 0.57) and FFI. CONCLUSION: SS is a disease that affects foot functionality in patients, with a greater impact on the pain scale. There is a correlation between the final FFI score and the final SySQ score, so improving foot functionality could help to improve the overall functionality of the patient with sclerosis.

Evaluating sustainability awareness and practices in podiatry clinics in Spain: A path toward a healthy and sustainable future.

2026-09-07T12:17:29Z

Título : Evaluating sustainability awareness and practices in podiatry clinics in Spain: A path toward a healthy and sustainable future. Autor : Chicharro-Luna, Esther; Gijon-Nogueron, Gabriel; Evans, Angela; Martínez Nova, Alfonso Resumen : Background Sustainability in healthcare is crucial due to the sector's significant contribution to global greenhouse gas emissions. Medical practices must address environmental impact while maintaining high-quality care and equitable access. In podiatry, sustainable practices can reduce the environmental footprint of clinics and improve long-term healthcare outcomes by promoting prevention and resource efficiency. Study design Cross sectional study. Method We conducted an online survey with 357 practicing podiatrists, all registered with the General Council of Podiatrists of Spain and with at least one year of professional experience. The survey contained 26 questions focused on sustainability in healthcare, podiatry practices, and environmental impact. The questionnaire included both closed-ended questions and Likert-scale items. Responses were scored and categorized into arbitrary sustainability categories: low (<12), medium (12 to 25), and high (>25). Results Most respondents (82.6 %) did not regularly use public transport, and 14 % did not engage in any form of physical exercise. More than half of the sample were unaware of the United Nations Sustainable Development Goals (SDGs). Almost all (98 %) had not measured the carbon footprint of their clinics, yet 34.7 % planned to optimise energy consumption in their clinics. Overall, 41.7 % were categorized as low sustainability, 56.9 % medium, and 1.4 % met high sustainability. Conclusions Podiatry clinics in Spain demonstrate low sustainability actions and knowledge. Sustainable practice aligns with global environment healthcare urgency, and ensures more responsible podiatric services. This study provides the first baseline data for this issue, availing comparisons across global podiatric healthcare sectors.

Concordance between sudomotor disorder and the clinical diagnosis of diabetic peripheral neuropathy, according to various clinical guidelines

2026-09-07T12:16:19Z

Título : Concordance between sudomotor disorder and the clinical diagnosis of diabetic peripheral neuropathy, according to various clinical guidelines Autor : Chicharro-Luna, Esther; Ortega-Avila, Ana Belen; Requena-Martínez, Aranza; Gijon-Nogueron, Gabriel Resumen : Aim: To assess the concordance between variations in Neuropad® results and the those in different diagnostic criteria of Diabetic Peripheral Neuropathy, according to various clinical guidelines. Methods: A descriptive observational study was conducted of 111 patients with a confirmed diagnosis of diabetes mellitus. The criteria for inclusion in the study were that patients should be aged 18 years or more and have at least 10 years’ history of diabetes mellitus. Results: 73 (65.8%) were male and 38 (34.2%) were female. Their mean age was 57.92 ± 13.24 years (95% CI 55.45–60.38). Healthy Neuropad® findings were obtained for 35 right feet (31.5%) and 31 left feet (27.9%). Conclusion: Neuropad® is an effective instrument for detecting macro and microvascular complications such as early-stage neuropathy, although its use should always be accompanied by a clinical examination of the foot.

Transcultural adaptation and validation of the Spanish version of the Global Pain Scale

2026-09-07T11:50:43Z

Título : Transcultural adaptation and validation of the Spanish version of the Global Pain Scale Autor : Ortega‐Avila, Ana Belen; Gijon-Nogueron, Gabriel; Cervera Garvi, Pablo; Guerra Marmolejo, Cristina; Chicharro-Luna, Esther; Reinoso Cobo, Andrés; Marchena‐Rodriguez, Ana Resumen : The aim of this study was to perform a cross‐cultural adaption and validation of the Global Pain Scale (GPS) to produce a Spanish‐language version (GPS‐Sp) and to determine the psychometric properties of this instrument. The GPS was cross‐culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. The initial study population was composed of 384 patients recruited from February to May 2021. All participants were aged at least 18 years and were currently experiencing pain. All gave signed informed consent to take part and completed the Brief Inventory‐Sp and GPS‐Spain questionnaires. Cronbach's ɑ and test/retest reliability values were calculated and floor/ceiling effects analyzed. Construct validity was assessed by confirmatory factor analysis (CFA). The 370 patients included in the final analysis presented the following characteristics: 36.2% were male and 63.8% were female; mean age 42.6 (19–88) years; mean body mass index 24.99. Internal consistency was good. The Cronbach's ɑ for GPS‐Sp was 0.86 and the intraclass correlation coefficient was 0.94 (95% CI; 0.87–0.97). Five main explanatory factors were identified by CFA, which produced the following values: RMSEA = 0.057; CFI = 0.807; GFI = 0.809; NFI = 0.763. No floor/ceiling effect was observed. The GPSSp is a valid, reliable and sensitive instrument for assessing pai

Foot deformities in patients with diabetic mellitus (with and without peripheral neuropathy)

2026-09-07T11:48:19Z

Título : Foot deformities in patients with diabetic mellitus (with and without peripheral neuropathy) Autor : Chicharro-Luna, Esther; Ortega-Avila, Ana Belen; Requena-Martínez, Aranzazu; Gijon-Nogueron, Gabriel Resumen : Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications in diabetes mellitus. It is the disorder that most commonly affects the feet of people with diabetes. The aim of the present study is to determine the relationship between DPN and the presence of deformities in the foot. Material and methods: A descriptive observational study was conducted of 111 patients diagnosed with Diabetes Mellitus (DM) type 1 or 2. All participants were aged at least 18 years and were previously informed in detail about the aims and procedures of the study. Results: Regarding the presence of DPN, the only significant relationships were found for the right foot with the deformity of the second toe (claw, hammer or mallet) (p = 0.017, OR 0.29 [0.10–0.83]) and for the left foot with the deformity of the second toe (p = 0.048; OR: 0.37 [0.14–1.01]), third toe (p = 0.012; OR: 0.29 [0.11–0.79]) and the presence of hallux extensus (p = 0.05; OR: 8.27 [1.05–64.98]). Conclusions: A significant number of foot deformities were observed among these patients with DM, regardless of the presence of DPN. These deformities should be carefully evaluated in order to determine the most appropriate treatment at an early stage, which will reduce the risk of ulceration. Although it should be use with caution to be transferrable to the general population with peripheral neuropathy.