Professors Adrian Heagerty and Deborah Falla are working at Solihull Hospital and the University of Birmingham, UK to understand how walking on sore feet affects the joints throughout the body. Blisters and thickened skin on the feet of people with Epidermolysis Bullosa Simplex (EBS) can make it hard to walk and cause additional problems with the ankles, knees, hips and spine. Specific exercises and custom-made shoes or insoles may be developed along with guidelines to help people with EB walk more comfortably throughout their lives. 


Grant Title: Gait Analysis in EB Simplex

Investigators: Professors Adrian Heagerty and Deborah Falla

Institution: Adult EB Team, Solihull Hospital Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham

Start Date: 1/10/2019 for 1 year

Grant amount:  £46,030.30


About this research and why it is important: 

Walking with sore feet or thickened areas of skin of the feet will always result in the feet not being placed properly on the ground, nor indeed, will the push off and landing of the feet be positioned in the normal way while walking.  In Epidermolysis Bullosa Simplex (EBS), with recurrent blistering and thickening of the skin there is tendency to walk on the sides of the feet to try to avoid sore areas. This will then lead to an abnormal positioning of the ankles, knees and hips which will not be the same on the left and right.  When people walk in this way, therefore, their hips move up and down causing the spine to “snake” and putting unnecessary stress on all the joints from the back downwards.


The researchers are running a pilot study of 20 patients with EBS to analyse the way in which they walk using a computerised room which can plot the positions of the joints, as well as the pressures exerted through the feet during walking in a gait laboratory. This has been arranged with the University of Birmingham in the Department of Rehabilitation and Physiotherapy, where the effects of such feet issues can be measured. Podiatrists from Solihull will also be looking at irregularities in the feet and pressures associated with walking to enable the researchers to develop custom built shoes and insoles to try to correct the unevenness of walking and see whether this improves the abnormalities of movement in the joints.

The team is aiming to optimize support for feet to help correct the posture and walking as much as possible. The researchers have found that there is also some muscle memory from having had problems over many years which will then need to be treated by exercising under the care of Professor Falla, a Professor of Rehabilitation at Birmingham University.  

It is hoped that this research will lead to development of a clinical protocol for gait analysis in EB, leading towards a clinical practice guideline and improved treatment and care for patients with EB that will allow them to maintain mobility throughout their lives.

Investigator Biographies:

Professor Adrian H M Heagerty BSc (Hons), MBBS, MRCP, MD, FRCP

Professor Adrian H M Heagerty BSc (Hons), MBBS, MRCP, MD, FRCP

Appointed as a Consultant Dermatologist at the Birmingham Skin Hospital in 1995, the opportunity arose in 1998 to start a new department of dermatology at Solihull Hospital, part of Birmingham Heartlands Hospital and is now the Heart of England Foundation Trust. Professor Heagerty has links with the research community in Epidermolysis Bullosa and Pachyonychia Congenita. In his work as senior registrar, he was able to identify families with EB Simplex, (EBS) which resulted in the determination of the underlying abnormality in EBS. Combined with work in Junctional and Dystrophic forms of EB, and latterly as lead for the NHS England half national adult service for such patients, Professor Heagerty was able to work closely with Prof WHI McLean, in the University of Dundee, exploring new technologies to inhibit gene expression, using the EB model as a paradigm. Professor Heagerty was appointed as Honorary Professor of Dermatology at The University of Birmingham, with sessions in the Institute of Inflammation and Ageing, working with Professor Chris Buckley, Kennedy Professor of Rheumatology, to explore the initiation of Psoriasis and Psoriatic Arthropathy, and with Professor Janet Lord and her colleagues examining the inflammatory responses and scarring in Dystrophic Epidermolysis Bullosa.

Deborah Falla, BPhty (Hons), PhD

Professor Deborah Falla

Professor Deborah Falla is Chair in Rehabilitation Science and Physiotherapy at the University of Birmingham, UK and is the Director of the Centre of Precision Rehabilitation for Spinal Pain (CPR Spine). Her research utilises state of the art electrophysiological and biomechanical measures to evaluate human movement and how it is affected or adapted in response to various states (e.g. injury, fatigue, pathology, training and pain). Her research interests also include optimisation of the management of musculoskeletal pain disorders with a particular interest in spinal pain. She has published over 190 papers in international, peer-reviewed journals, more than 300 conference papers/abstracts including over 35 invited/keynote lectures and has received several recognitions and awards for her work including the German Pain Research Prize in 2014, the George J. Davies - James A. Gould Excellence in Clinical Inquiry Award in 2009 and the Delsys Prize for Electromyography Innovation in 2004. Professor Falla is an author/editor of three books including the latest entitled “Management of neck pain disorders: a research informed approach” (Elsevier). Professor Falla acts as an Associate Editor for Musculoskeletal Science & Practice, the Journal of Electromyography and Kinesiology and IEEE Transactions on Neural Systems and Rehabilitation Engineering. She was President of the International Society of Electrophysiology and Kinesiology (ISEK) from 2016 to 2018.