Theses and Dissertations at Montana State University (MSU)
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Item The effects of angled insoles on short radius flat-track running mechanics(Montana State University - Bozeman, College of Engineering, 2023) Bianchini, Christopher David; Chairperson, Graduate Committee: Corey PewWhile indoor track allows athletes to compete during the winter period of December to February, injury rates during the indoor track and field season are 16% higher than the outdoor season. Increases in injury rates are often attributed to the shorter turn radii experienced by athletes when competing on a 200m indoor track as opposed to the longer turn radii of a 400m outdoor track. A common method of counteracting these asymmetries is to bank the turns of a 200m indoor track. Aligning the athlete's resultant force vector perpendicular to the running surface can alleviate many of the running form abnormalities caused by turn running. However, the high cost of implementing a banked indoor track can be prohibitive to many programs who currently have a flat track facility. To this end, we have developed two experimental insoles designed to alleviate the asymmetries experienced during turn running: a physically angled foam insole and an insole containing an angled stiff mid-plate. Insole function was tested through human participant running trials to identify their effects on indoor flat track running mechanics. 12 NCAA Division 1 track and field athletes (6 male, 6 female, age: 21 + or - 2 years, mass: 61.4 + or - 11.4 kg, height: 1.77 + or - 0.17 m) who specialize in distance and mid-distance running provided informed consent to participate in this Institutional Review Board-approved protocol. Kinematics, muscle activation, and ground interaction variables were monitored during running trials and used to compare the effects of the insoles on running biomechanics. The physically angled insole produced positive results for ankle joint angles and ground interaction variables for turn running. The angled plate insole positively affected right-side ankle joint angle positioning and did not significantly impact straight running mechanics. Both insoles produced higher levels of muscle activation asymmetry, indicating that this may be a required effect of turn running regardless of joint angle positioning and ground interaction. While the angled plate insoles showed almost no impact on straight or turn running mechanics, the wedge insoles functioned effectively to alleviate several asymmetries related to turn running.Item Improving diabetic foot evaluations and podiatry referrals in primary care(Montana State University - Bozeman, College of Nursing, 2023) Holland, Courtney Alyssa; Chairperson, Graduate Committee: Amanda H. LucasDiabetic foot ulcers (DFU) are responsible for over 5% of diabetic deaths. DFUs can be prevented or delayed with early diagnosis and treatment of associated diabetic foot complications by utilizing annual comprehensive diabetic foot evaluations (DFE). Despite this, diabetics are not receiving evaluations per the American Diabetes Association's (ADA) recommendations on timeliness and completeness. The potential problem was identified and a needs assessment was undertaken to diagnose the need for change in practice. At one provider clinic in central Montana, less than two-thirds of diabetic adults received a DFE at their annual exam, compared to the national benchmark of 74.8%. Next, a literature review was utilized to gather and analyze evidence. The best solution was identified and a quality improvement project was proposed. Using the Plan-Do-Check-Act cycle, the outcomes were measured preintervention and weekly after implementation. Outcomes included: rates of Michigan Neuropathy Screening Instrument (MNSI), ADA risk assessment, DFE documentation, and podiatry referral completion. The 6- week project focused on nurse practitioner practice change including staff education, implementation of the DFE tools (MNSI and ADA risk assessment), documentation template, and new process flow. Podiatry referrals were included in the new process for patients who screened positive on the MNSI and ADA risk assessment. One hundred percent of patients received an MNSI, ADA risk assessment, documented DFE, and podiatry referral, when indicated. Only 96.67% of patients received an annual DFE that was congruent with the ADA guidelines, with one patient having an incomplete neurological exam documented in their chart. Improvement in rates of timeliness and completeness of DFEs and podiatry referrals were observed when utilizing these standardized assessments and processes. The project culminated in a reflective evaluation of how Montana State University's Doctor of Nursing Practice (DNP) program met the DNP essentials required for graduation.Item Using a beam theory model to quantify metatarsal bone stress during running(Montana State University - Bozeman, College of Education, Health & Human Development, 2023) McKibben, Kaitlyn Marie; Chairperson, Graduate Committee: James N. Becker; This is a manuscript style paper that includes co-authored chapters.Running is a common fitness activity that is associated with a high incidence of overuse injuries, including metatarsal stress fractures. One contributor to stress injury is repetitive loading of the metatarsals without adequate recovery time and experiencing larger volumes and magnitudes of bone loading may increase injury risk. Thus, quantifying metatarsal loads can be beneficial to understanding injury risk. However, it is currently difficult to estimate bone stress in clinical settings and unclear how bone stress changes following a long run. Therefore, the purpose of this thesis was to 1) characterize changes in metatarsal bone stress before and after the completion of a long-distance run, and 2) suggest a clinically feasible method for estimating metatarsal bone stress. Study 1 involved 21 healthy long-distance runners who ran 25% of their average weekly mileage on an instrumented treadmill. Foot kinematics, ground reaction forces, and in-shoe plantar pressures were collected at the beginning and end of the run and a mathematical model was used to estimate bone stresses and bending moments for all five metatarsals. Plantar stress, dorsal stress, and midshaft bending moments in the second and third metatarsals were greater after the completion of the run. This is consequential for injury risk because the second and third metatarsals are the most susceptible to stress fracture development. In study 2, seventeen runners ran barefoot across a force plate overlaid with a plantar pressure mat while foot kinematics were recorded. The same mathematical model of the metatarsals was used to estimate third metatarsal bone stresses and bending moments, and linear regressions determined whether force or pressure beneath the metatarsal predicted bone loads. A model containing head and base pressure differentials and force beneath the metatarsal head was the best predictor of bone loading, indicating that the use of plantar pressure measurements as a surrogate measure of bone stress could be a time and cost-effective method for estimating bone stress in clinical settings. Moving forward, elucidating how metatarsal bone stress changes over the course of a long run and finding more accessible ways to quantify bone stress could help alleviate injury risk.Item A descriptive analysis of the relationship between leg alignment and Achilles tendonitis(Montana State University - Bozeman, College of Education, Health & Human Development, 1977) Courtney, Anne Gerard