Sara Zúnica-García

Background/Objectives: Foot problems are common in fibromyalgia syndrome (FMS) and may be related to pain, kinesiophobia, and concern about falling. This study examined associations between foot function, kinesiophobia, and concern about falling in adults with FMS and identified factors independently associated with worse foot function. Methods: Adults with clinically diagnosed FMS were assessed between December 2024 and April 2025 in this cross-sectional study. Foot function was evaluated using the Foot Function Index (FFI), kinesiophobia with the Tampa Scale for Kinesiophobia-11 (TSK-11), and concern about falling with the Falls Efficacy Scale–International (FES-I). Multivariable linear regression identified factors independently associated with total FFI score. Results: Among 444 participants, 95.3% were women. The mean FFI score was 52.28 ± 23.24/100, with pain showing the greatest impairment. The mean TSK-11 and FES-I scores were 29.21 ± 7.91 and 39.73 ± 12.41, respectively. FFI scores were associated with both TSK-11 and FES-I scores in bivariate analyses (p < 0.001). In multivariable analysis (adjusted R² = 0.366), older age was associated with lower FFI scores, whereas higher BMI, smoking history, rheumatoid arthritis, and higher FES-I scores were independently associated with worse foot function. Conclusions: Foot dysfunction in FMS was associated with kinesiophobia and concern about falling, but only concern about falling remained independently associated after adjustment. Higher BMI, smoking history, and rheumatoid arthritis were also associated with worse foot function. Assessment of concern about falling may provide complementary information when evaluating foot-related functional impairment in individuals with FMS.

Background: Long-distance hiking usually requires carrying a backpack, adding external load to the lower limbs and modifying plantar loading patterns. Excessive loads may contribute to overuse injuries, but quantitative evidence to support current recommendations on backpack weight is still scarce. This study aimed to examine how different backpack loads influence plantar pressure in long-distance hikers. Methods: A cross-sectional observational study was conducted in adults who had walked at least 20 km during the previous 24 h. Sociodemographic and clinical variables were recorded, and barefoot plantar pressure was assessed using the Podoprint^® system under four conditions: without a backpack, with the habitual backpack, and with backpacks loaded to 10% and 20% of body weight. Static and dynamic plantar pressure parameters were analyzed using repeated-measures comparisons. Results: A progressive increase in plantar force was observed in both feet as backpack load increased. Compared with the unloaded condition, static forefoot pressure rose by 5.41% with a 10% load and by 8.73% with a 20% load (p = 0.005); rearfoot pressure increased by 5.01% and 10.17% (p = 0.015); and total foot pressure by 5.04% and 9.61% (p = 0.002). Loads above 10% of body weight significantly modified static plantar pressures and were associated with measurable changes during dynamic assessment. Conclusions: In long-distance hikers, carrying a backpack that exceeds approximately 10% of body weight leads to a clear, load-dependent increase in plantar pressure. These findings provide biomechanical support for recommendations that advise limiting backpack load to around 10% of body weight to reduce plantar stress during hiking.

Background: Diabetic peripheral neuropathy (DPN) is a common and serious complication of diabetes mellitus, affecting sensory, motor, and autonomic nerves. It increases the risk of foot ulceration and falls. Management typically involves preventive strategies like patient education, risk stratification, and regular foot screenings. Exercise plays a key role in enhancing glycemic control and nerve function, reducing the risk of DPN and related complications. This umbrella review aimed to evaluate the impact of different exercise interventions on patients with DPN. Methods: The search was conducted in the following databases: Pubmed, Scopus, Cochrane Library, Embase, and SPORTDiscus, from the establishment of the database up to the search date (September 11, 2023). We included systematic reviews and meta-analyses assessing exercise interventions in adults with type 1 or type 2 diabetes and DPN. Studies were selected based on predefined PICO criteria. The methodological quality of included reviews was assessed using the AMSTAR-2 tool. Results were synthesized narratively and categorized by exercise type and health outcome. Results: Fourteen reviews were included, examining the effects of various exercise interventions. Duration ranged from one week to 12 months, and studies were conducted in multiple countries. Additionally, we extracted and reanalyzed individual results from 70 primary studies included within the reviews. Some meta-analyses reported significant improvements in fasting glucose and HbA1c (n = 1), neuropathic symptoms (n = 3), physical function (n = 1), static and dynamic balance (n = 2), range of motion (n = 1), and fear of falling (n = 1). No significant effects were found for BMI, ulcer incidence, adverse events, weight-bearing activity, quality of life, or forefoot plantar pressure (n = 1). Outcome assessment tools included the Biodex system (n = 9), single-leg stance (n = 8), Berg Balance Scale (n = 11), and Timed Up and Go (n = 13) for balance; nerve conduction velocity (n = 8), MNSI (n = 6), and Total Symptom Score (n = 3) for nerve function; fasting glucose (n = 3) and HbA1c (n = 5) for glycemic control. Other outcomes included muscle strength (n = 6), functional capacity (n = 6), pain (n = 6), and quality of life (n = 6). Conclusions: Exercise training appears to have potential benefits for certain aspects of DPN, neuropathic symptoms, and functional capacity. However, the effects on glycemic control, fall risk reduction, and ulcer prevention remain inconclusive, with significant variability in study outcomes.

Alterations in static plantar pressure distribution serve as important indicators of gait and balance impairments in individuals with Multiple Sclerosis (MS). In addition, the identification of altered patterns of plantar load distribution, along with restricted ankle dorsiflexion, may serve as early markers of postural instability and gait dysfunction in women with MS. Objectives: To assess differences in static plantar pressure, load distribution, and ankle dorsiflexion range of motion between women diagnosed with MS and women without the condition. Methods: A cross-sectional observational study was conducted between April and December 2024. Women with MS were recruited from patient associations in the provinces of Alicante and Murcia, as well as from the neurology outpatient clinic at the Doctor Balmis University Hospital (Alicante, Spain). Static postural assessment was performed using the Neo-Plate^® pressure platform, which measured maximum and mean plantar pressure (kPa), load distribution (%), contact surface area (cm²), and anterior–posterior weight distribution between the forefoot and rearfoot. The ankle dorsiflexion range of motion was assessed with a universal two-arm goniometer. All parameters were compared with those of a group of women without a diagnosis of MS. Results: Compared to women without MS, participants with MS showed a significantly greater load on the right forefoot (25.75% vs. 23.41%, p = 0.021), and reduced load on the right (23.09% vs. 26.01%, p = 0.004) and left rearfoot (26.60% vs. 30.85%, p = 0.033). Total forefoot loading was significantly higher (52.33% vs. 46.40%, p < 0.001), and rearfoot loading was lower (47.64% vs. 52.42%, p = 0.006) in the MS group. Ankle dorsiflexion range of motion was also significantly reduced in women with MS, both with the knee flexed (5.95° ± 4.50 and 6.76° ± 4.69 vs. 15.45° ± 5.04 and 14.90° ± 5.43) and extended (2.69° ± 3.69 and 3.12° ± 3.83 vs. 8.17° ± 3.41 and 8.60° ± 3.31), with all differences reaching statistical significance (p < 0.001). Conclusions: Women with MS present significant alterations in static plantar load distribution, with increased forefoot and decreased rearfoot loading, as well as markedly reduced ankle dorsiflexion, in comparison to women without the disease. These findings suggest the presence of postural imbalances associated with MS, potentially affecting functional stability and mobility.

Friction blisters are common among outdoor enthusiasts, yet their causes remain uncertain. This study aimed to compare foot hydration in long‐distance hikers with and without blisters, and to assess variability based on age and sex. An observational case–control study involving 86 hikers was conducted. Skin hydration was measured using a corneometer on various foot zones. Data on blister count, footwear, sex, age, and temperature were recorded. The most hydrated zones were the digital area, forefoot, and heel. Higher hydration was found in the blister group (61.6%) compared to the control group (38.4%). A significant relationship between hydration and blisters was observed in the left foot (p = 0.032). Total foot hydration was higher in women (p = 0.007) and inversely related to age (r = −0.333; p = 0.002). Hydration values above 30.40 a.u. in the right foot and 27.37 a.u. in the left foot were linked to blisters with 80% sensitivity. This study highlights the variability in foot hydration and its relationship with blisters. The influence of age and wet socks underscores the complexity of blister formation, emphasizing the need for future research on effective prevention.

Objective: To evaluate the morphofunctional alterations in the foot and their association with functionality, considering aspects such as disability, pain, and limitations in daily activities in patients with fibromyalgia syndrome (FMS). Methods: A case–control study was conducted in patients with FMS (case group) and without FMS (control group), matched by age and sex. Foot posture was assessed using the foot posture index (FPI), along with the presence of hallux valgus (HV), trigger points, hyperkeratosis, and dorsiflexion of the first metatarsophalangeal joint and ankle. Foot functionality was evaluated using the foot function index (FFI) questionnaire. Results: A total of 100 women with FMS and 100 women without FMS, with a mean age of 61.97 ± 9.26 years, were recruited. HV (p < 0.001), hyperkeratosis (p < 0.001), pronated and supinated foot (p < 0.001), as well as limitations in dorsiflexion of the first metatarsophalangeal joint (p < 0.001) and the ankle with the knee flexed (p < 0.001) and extended (p < 0.001), along with the activity of the flexor hallucis brevis (p = 0.006), adductor hallucis (p = 0.006), and dorsal interosseous (p = 0.002) muscles, were significantly associated with the FFI, being higher in individuals with FMS, indicating greater impairment of foot functionality in these patients. Multivariate analysis revealed a statistical association between FMS and low educational level (OR = 2.57, 95% CI 1.05–5.72), the presence of another rheumatic disease (OR = 5.07, 95% CI 2.34–11), and the presence of any active trigger point (OR = 11.15, 95% CI 3.97–31.31). Conclusions: The study highlights the relationship between morphofunctional foot alterations, specifically the presence of active myofascial trigger points, and functionality in patients with FMS.