Limited joint mobility in the hand is a common manifestation of diabetes with the reported prevalence in insulin-dependent diabetes varying between 8 and 43%. Sixty-two subjects were studied in three groups (controls, diabetic patients without foot problems, and diabetic patients with neuropathic ulceration) to determine whether similar changes occur in the joints of the foot and to examine any possible relationship with neuropathic ulceration. There was a significant impairment of mobility in the range of motion of the sub-talar joint in diabetic patients with ulcers when compared with controls (p = 0.0001) or with the other diabetic patients (p = 0.004). There was a significant correlation between sub-talar range of motion and mobility in other joints of the foot such as at the hallux (r = 0.59, p less than 0.001), or with mobility of the 5th finger (r = 0.41, p less than 0.01). There was also a significant association between the clinical presence of limited joint mobility in the hand, Dupuytren's contracture, and mobility of the sub-talar joint (p less than 0.05). Furthermore, impairment of mobility of the sub-talar joint was greatest on the affected side in those diabetic patients with neuropathic ulceration (p = 0.029). We conclude that the syndrome of limited joint mobility also affects the joints of the feet of diabetic patients and may predispose to ulceration in susceptible neuropathic feet.

In Australia workers in many industries are required to wear safety footwear (footwear incorporating a steel toe cap). An investigation of the problems reported by 321 workers (70 per cent male) employed in a broad range of work activities and required to wear safety footwear was conducted in 1990 and 1991. Respondents were interviewed by a professionally trained podiatrist using a structured questionnaire followed by a foot examination. An extremely high percentage (91 per cent) of subjects reported one or more foot problems (which were verified by the podiatrist), and most considered that the safety footwear either caused the problem or adversely affected an existing foot condition. The main shoe concerns reported were excessive heat (65 per cent of all respondents), inflexible soles (52 per cent), weight (48 per cent) and pressure from steel toe cap (47 per cent). Certain gender differences were identified. General recommendations are made.

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The case history is reported of a 56 year old male patient with heel pain. The treatment consisted of the design of a cushioned accomodative orthotic with high density rubber cushioning (Rubazote). The Podiatrist and technician combined to fabricate an orthotic device which relieved the heel pain. The orthotic was fabricated form heavy rubazote in order to cushion the heel strike. An assessment of the gait pattern and subsequent adjustment to the foot-ankle complex resulted in a satisfactory treatment.