Dr Angela Searle
Casual Research Assistant
School of Health Sciences
- Phone:(02) 4348 4996
Angela's PhD topic was 'The effectiveness of a stretching intervention in lowering plantar pressures related to reduced ankle range of motion in people with diabetes.’
This came about from an interest in shifting funding and research priorities towards a preventative approach, rather than the current heavy focus on treatment after the onset of foot complications. The aim was to investigate a simple, non-invasive and inexpensive preventative intervention that could be implemented by a wide variety of primary care clinicians including podiatrists, physiotherapists and diabetic nursing staff.
She has a continuing interest in all aspects of primary care research including participation in randomised controlled trials, systematic reviews and reliability and accuracy investigations.
- Doctor of Philosophy in Podiatry, University of Newcastle
- Bachelor of Applied Science (Complementary Med), Royal Melbourne Institute of Technology
- Master of Applied Science (Acupuncture), Royal Melbourne Institute of Technology
- Diabetes foot
- Exercise therapy
- Plantar Pressures
- Randomised controlled trial
- Systematic review
- English (Mother)
For publications that are currently unpublished or in-press, details are shown in italics.
Journal article (13 outputs)
Linton C, Searle A, Hawke F, Tehan PE, Chuter V, 'Nature and extent of outpatient podiatry service utilisation in people with diabetes undergoing minor foot amputations: a retrospective clinical audit.', J Foot Ankle Res, 14 6 (2021)
Chuter VH, Searle A, Barwick A, Golledge J, Leigh L, Oldmeadow C, et al., 'Estimating the diagnostic accuracy of the ankle-brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta-analysis.', Diabet Med, 38 e14379 (2021)
Linton C, Searle A, Hawke F, Tehan PE, Sebastian M, Chuter V, 'Do toe blood pressures predict healing after minor lower limb amputation in people with diabetes? A systematic review and meta-analysis', DIABETES & VASCULAR DISEASE RESEARCH, 17 (2020) [C1]
Chuter V, West M, Hawke F, Searle A, 'Where do we stand? the availability and efficacy of diabetes related foot health programs for Aboriginal and Torres Strait Islander Australians: A systematic review', Journal of Foot and Ankle Research, 12 1-12 (2019) [C1]
Searle A, Spink MJ, Oldmeadow C, Chiu S, Chuter VH, 'Calf muscle stretching is ineffective in increasing ankle range of motion or reducing plantar pressures in people with diabetes and ankle equinus: A randomised controlled trial', Clinical Biomechanics, 69 52-57 (2019) [C1]
© 2019 Elsevier Ltd Background: Limited ankle dorsiflexion, or equinus, is associated with elevated plantar pressures, which have been implicated in the development and non-healin... [more]
© 2019 Elsevier Ltd Background: Limited ankle dorsiflexion, or equinus, is associated with elevated plantar pressures, which have been implicated in the development and non-healing of foot ulcer. A stretching intervention may increase ankle dorsiflexion and reduce plantar pressures in people with diabetes. Methods: Two arm parallel randomised controlled trial from September 2016 to October 2017. Adults with diabetes and ankle equinus (=5° dorsiflexion) were randomly allocated to receive an 8 week static calf stretching intervention or continue with their normal activities. Primary outcome measures were change in weight bearing and non-weight bearing ankle dorsiflexion and forefoot peak plantar pressure. Secondary outcome measures were forefoot pressure time integrals and adherence to the stretching intervention. Findings: 68 adults (mean (standard deviation) age and diabetes duration 67.4 (10.9) years and 14.0 (10.8) years, 64.7% male) were randomised to stretch (n = 34) or usual activity (n = 34). At follow up, no significant differences were seen between groups (adjusted mean difference) for non-weight (+1.3°, 95% CI:-0.3 to 2.9, p = 0.101) and weight bearing ankle dorsiflexion (+0.5°, 95% CI:-2.6 to 3.6, p = 0.743) or forefoot in-shoe (+1.5 kPa, 95% CI:-10.0 to 12.9, p = 0.803) or barefoot peak pressures (-19.1 kPa, 95% CI:-96.4 to 58.1, p = 0.628). Seven of the intervention group and two of the control group were lost to follow up. Interpretation: Our data failed to show a statistically significant or clinically meaningful effect of static calf muscle stretching on ankle range of motion, or plantar pressures, in people with diabetes and ankle equinus.
Johnson NA, Barwick AL, Searle A, Spink MJ, Twigg SM, Chuter VH, 'Self-reported physical activity in community-dwelling adults with diabetes and its association with diabetes complications', Journal of Diabetes and its Complications, 33 33-38 (2019) [C1]
© 2018 Elsevier Inc. Aims: To describe the physical activity levels of an Australian community-based adult population with diabetes, and investigate the interaction between diabet... [more]
© 2018 Elsevier Inc. Aims: To describe the physical activity levels of an Australian community-based adult population with diabetes, and investigate the interaction between diabetes complications and physical activity. Methods: Anthropometric, demographic, biochemical and self-reported physical activity measures (IPAQ) were performed. Associations and multiple regression analyses were undertaken between physical activity, known risk factors for diabetes complications, and history of cardiovascular disease (CVD), neuropathy and foot ulceration obtained from medical records. Results: 240 participants were recruited (96% type 2 diabetes; age 68.7 ± 10.5 y; 58% men; diabetes duration 14.3 ± 11.4 y). Sixty seven percent of participants reported undertaking moderate or vigorous intensity exercise to recommended levels, and 29% reported no moderate-vigorous exercise. In addition to being associated with known demographic and biochemical risk factors and other complications, diabetes complications were also associated with different physical activity behaviours. Individuals with a history of CVD were more likely to participate in moderate-vigorous exercise and meet exercise guidelines, individuals with neuropathy undertook less walking and moderate intensity exercise, and those with a history of foot ulceration sat more and participated less in vigorous exercise. Conclusions: In Australian adults, the presence of diabetes complications may influence physical activity participation, and associate with characteristic physical activity approaches.
Searle A, Spink MJ, Chuter VH, 'Weight bearing versus non-weight bearing ankle dorsiflexion measurement in people with diabetes: a cross sectional study', BMC MUSCULOSKELETAL DISORDERS, 19 (2018) [C1]
Searle A, Spink MJ, Chuter VH, 'Validation of a weight bearing ankle equinus value in older adults with diabetes', Journal of Foot and Ankle Research, 11 (2018) [C1]
Searle A, Spink MJ, Chuter VH, 'Prevalence of ankle equinus and correlation with foot plantar pressures in people with diabetes', Clinical Biomechanics, 60 39-44 (2018) [C1]
© 2018 Elsevier Ltd Background: An association between equinus and plantar pressure may be important for people with diabetes, as elevated plantar pressure has been linked with fo... [more]
© 2018 Elsevier Ltd Background: An association between equinus and plantar pressure may be important for people with diabetes, as elevated plantar pressure has been linked with foot ulcer development. To determine the prevalence of equinus in community dwelling people with diabetes and to examine any association between presence of equinus and forefoot plantar pressures. Methods: Barefoot (Tekscan HR Mat¿) and in-shoe (Novel Pedar-X®) plantar pressure variables, non-weight bearing ankle range of motion and neuropathy status were assessed in 136 adults with diabetes (52.2% male; 47.8% with neuropathy; mean (standard deviation) age and diabetes duration: 68.4 (11.5) and 14.6 (11.1) years respectively). Findings: Equinus, when measured as =5° dorsiflexion, was present in 66.9% of the cohort. There was a significant correlation between an equinus and barefoot (r = 0.247, p = 0.004) and in-shoe forefoot pressure time integrals (r = 0.214, p = 0.012) and in-shoe forefoot alternate pressure time integrals (r = 0.246, p = 0.004). Significantly more males (p < 0.01) and people with neuropathy (p = 0.02) or higher glycated haemoglobin levels (p < 0.01) presented with an equinus. Interpretation: Community dwelling adults with diabetes have a high rate of ankle equinus which is associated with increased forefoot pressure time integrals and a two-fold increased risk of high in-shoe peak pressures. Clinical assessment of an ankle equinus may be a useful screening tool to identify adults at increased risk of diabetic foot complications.
Searle A, Spink MJ, Ho A, Chuter VH, 'Association between ankle equinus and plantar pressures in people with diabetes. A systematic review and meta-analysis', Clinical Biomechanics, 43 8-14 (2017) [C1]
© 2017 Elsevier Ltd Background Diabetes is one of the most common chronic diseases in the world and is associated with a life-time risk of foot ulcer of 12¿25%. Diabetes related r... [more]
© 2017 Elsevier Ltd Background Diabetes is one of the most common chronic diseases in the world and is associated with a life-time risk of foot ulcer of 12¿25%. Diabetes related restriction in ankle joint range of dorsiflexion is proposed to contribute to elevated plantar pressures implicated in the development of foot ulcers. Methods A systematic search of EBSCO Megafile Premier (containing MEDLINE, CINAHL, SPORTSdiscus and Academic Search Complete) and The Cochrane Library was conducted to 23rd November 2016. Two authors independently reviewed and selected relevant studies. Meta-analysis of study data were conducted where possible. Findings Fifteen studies met the inclusion criteria. Three studies were eligible to be included in the meta-analysis which found that equinus has a significant, but small, effect on increased plantar pressures (ES¿=¿0.26, CI 95% 0.11 to 0.41, p¿=¿0.001). Of the remaining studies, eight found evidence of an association between limited ankle dorsiflexion and increased plantar pressures while four studies found no relationship. Interpretation Limited ankle joint dorsiflexion may be an important factor in elevating plantar pressures, independent of neuropathy. Limited ankle dorsiflexion and increased plantar pressures were found in all the studies where the sample population had a history of neuropathic foot ulceration. In contrast, the same association was not found in those studies where the population had neuropathy and no history of foot ulcer. Routine screening for limited ankle dorsiflexion range of motion in the diabetic population would allow for early provision of conservative treatment options to reduce plantar pressures and lessen ulcer risk.
Chuter VH, Searle A, Spink MJ, 'Flip-flop footwear with a moulded foot-bed for the treatment of foot pain: a randomised controlled trial', BMC Musculoskeletal Disorders, 17 1-8 (2016) [C1]
© 2016 The Author(s). Background: Foot pain is a common problem affecting up to 1 in 5 adults and is known to adversely affect activities of daily living and health related qualit... [more]
© 2016 The Author(s). Background: Foot pain is a common problem affecting up to 1 in 5 adults and is known to adversely affect activities of daily living and health related quality of life. Orthopaedic footwear interventions are used as a conservative treatment for foot pain, although adherence is known to be low, in part due to the perception of poor comfort and unattractiveness of the footwear. The objective of this trial was to assess the efficacy of flip-flop style footwear (Foot Bio-Tec©) with a moulded foot-bed in reducing foot pain compared to participant's usual footwear. Methods: Two-arm parallel randomised controlled trial using computer generated random allocation schedule at an Australian university podiatry clinic. 108 volunteers with disabling foot pain were enrolled after responding to an advertisement and eligibility screening. Participants were randomly allocated to receive footwear education and moulded flip-flop footwear to wear as much as they were comfortable with for the next 12 weeks (n = 54) or footwear education and instructions to wear their normal footwear for the next 12 weeks (n = 54). Primary outcome was the pain domain of the Foot Health Status Questionnaire (FHSQ). Secondary outcomes were the foot function and general foot health domains of the FHSQ, a visual analogue scale (VAS) for foot pain and perceived comfort of the intervention footwear. Results: Compared to the control group, the moulded flip-flop group showed a significant improvement in the primary outcome measure of the FHSQ pain domain (adjusted mean difference 8.36 points, 95 % CI 5.58 to 13.27, p < 0.01). Statistical and clinically significant differences were observed for the secondary measure of foot pain assessed by a VAS and the FSHQ domains of foot function and general foot health. None of the participants reported any pain or discomfort from the intervention footwear and six (footwear group = 4) were lost to follow up. Conclusions: Our results demonstrate that flip-flop footwear with a moulded foot-bed can have a significant effect on foot pain, function and foot health and might be a valuable adjunct therapy for people with foot pain.
Searle A, Spink M, Ho A, Chuter V, 'Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials', Clinical Rehabilitation, 29 1155-1167 (2015) [C1]
© The Author(s) 2015. Objective: To determine, for adults with chronic low back pain, which exercise interventions are the most effective at reducing pain compared to other treatm... [more]
© The Author(s) 2015. Objective: To determine, for adults with chronic low back pain, which exercise interventions are the most effective at reducing pain compared to other treatments. Data sources: A search of MEDLINE, CINAHL, EMBASE, SPORTDiscus, PsycINFO and The Cochrane Library was conducted up to October 2014. Review methods: Databases were searched for published reports of randomised trials that investigated the treatment of chronic low back pain of non-specific origin with an exercise intervention. Two authors independently reviewed and selected relevant trials. Methodological quality was evaluated using the Downs and Black tool. Results: Forty-five trials met the inclusion criteria and thirty-nine were included in the meta-analysis. Combined meta-analysis revealed significantly lower chronic low back pain with intervention groups using exercise compared to a control group or other treatment group (Standard Mean Deviation (SMD) =-0.32, CI 95% -0.44 to -0.19, P<0.01). Separate exploratory subgroup analysis showed a significant effect for strength/resistance and coordination/stabilisation programs. Conclusions: Our results found a beneficial effect for strength/resistance and coordination/stabilisation exercise programs over other interventions in the treatment of chronic low back pain and that cardiorespiratory and combined exercise programs are ineffective.
Chuter V, Spink M, Searle A, Ho A, 'The effectiveness of shoe insoles for the prevention and treatment of low back pain: A systematic review and meta-analysis of randomised controlled trials', BMC Musculoskeletal Disorders, 15 1-8 (2014) [C1]
|Show 10 more journal articles|
Conference (3 outputs)
Chuter VH, Spink MJ, Searle A, Sadler SG, Ho A, ''A systematic review and meta-analysis of randomised controlled trials investigating the effectiveness of foot orthotic devices for the prevention and treatment of low back pain', POSTER', Singapore (2016)
Chuter V, Sadler SG, Searle A, 'Footwear related pain and running related injuries', QLD (2015) [E3]
Spink MJ, Chuter VH, Searle A, 'Flip-flop footwear with a moulded foot-bed for the treatment of foot pain: A randomised controlled trial', Hope Island, Gold Coast (2015) [E3]
Grants and Funding
|Number of grants||1|
Click on a grant title below to expand the full details for that specific grant.
20181 grants / $22,862
Does screening for ankle joint restriction have a role in preventing diabetic foot ulceration$22,862
Funding body: Hunter Medical Research Institute
March 17, 2017
Dr Angela Searle
Casual Research Assistant
School of Health Sciences Faculty of Health
School of Health Sciences
College of Health, Medicine and Wellbeing
|Phone||(02) 4348 4996|
|Building||BE - Facultly of Health Sciences|
10 Chittaway Road
Ourimbah, NSW 2258