Podiatry Clinic Research Articles

Evaluating sustainability awareness and practices in podiatry clinics in Spain: a path toward a healthy and sustainable future

Background: Sustainability in healthcare is crucial due to the sector's significant contribution to global greenhouse gas emissions. Medical practices must address environmental impact while maintaining high-quality care and equitable access. In podiatry, sustainable practices can reduce the environmental footprint of clinics and improve long-term healthcare outcomes by promoting prevention and resource efficiency. Study design: Cross sectional study Method: We conducted an online survey with 357 practicing podiatrists, all registered with the General Council of Podiatrists of Spain and with at least one year of professional experience. The survey contained 26 questions focused on sustainability in healthcare, podiatry practices, and environmental impact. The questionnaire included both closed-ended questions and Likert-scale items. Responses were scored and categorized into arbitrary sustainability categories: low (<12), medium (12 to 25), and high (>25). Results: Most respondents (82.6%) did not regularly use public transport, and 14% did not engage in any form of physical exercise. More than half of the sample were unaware of the United Nations Sustainable Development Goals (SDGs). Almost all (98%) had not measured the carbon footprint of their clinics, yet 34.7% planned to optimise energy consumption in their clinics. Overall, 41.7% were categorized as low sustainability, 56.9% medium, and 1.4% met high sustainability. Conclusions: Podiatry clinics in Spain demonstrate low sustainability actions and knowledge. Sustainable practice aligns with global environment healthcare urgency, and ensures more responsible podiatric services.. This study provides the first baseline data for this issue, availing comparisons across global podiatric healthcare sectors.

Identification of High-Risk Lower Extremity Wounds Using Point-of-Care Test for Bacterial Protease Activity; A Single-Centre, Single-Blinded, Prospective Study.

Clinician observation is the mainstay to determine if wound infection is present, and focuses on presence of erythema, purulence, and odour. However, non-visible bacterial protease activity can delay wound healing and lead to complications. In this study, a point-of-care test to detect the presence of bacterial protease activity (BPA, tested with Woundchek Bacterial Status test) was appraised. A total of 130 patients with lower extremity wounds were recruited in vascular and podiatry clinics, and across two time-points 182 BPA tests were conducted subsequent to initial (blinded) clinician's wound appraisal. Clinical opinion ('no infection', 'possible' or 'definite' infection) and BPA result (negative or positive test) had a moderate Kendall's tau-c rank correlation coefficient of 0.32 (P < 0.001). Binary logistic regression analysis and principal component analysis showed that infection determined by clinical opinion was significantly associated with abovementioned clinical signs and a positive BPA test. However, a positive BPA result was also significantly linked with wound severity, such as number of lesions, chronicity and size. Throughout a 12-week follow-up period, median ulcer size was larger for wounds positive for BPA test at baseline (P 0.001) and week-12 (P 0.036; both Mann-Whitney U-test) respectively. As a pilot initiative, clinical staff were allowed to act on the BPA result if they wished; in 11 out of 71 test-positive cases (15%) this happened and antimicrobial dressing was applied instead of planned standard dressing. These results show that protease-releasing bacteria may be active in ulcers that do not (yet) exhibit hallmark signs of infection, and are associated with delayed healing. Targeted point-of-care testing for bacterial protease activity may have the potential to identify and enable pro-active (antimicrobial) management of these high-risk wounds.

Describing the development and implementation of a novel collaborative multidisciplinary approach to deliver foot health supports for individuals experiencing homelessness and its outcomes.

Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point.

Can routine assessment of older people's mental health lead to improved outcomes: A regression discontinuity analysis.

To assess whether case finding for depression among people aged 65 and above improves mental health. Opportunistic evaluation using a regression discontinuity analysis with data from a randomised controlled trial. The REFORM trial, a falls prevention study that recruited patients from NHS podiatry clinics. 1010 community-dwelling adults over the age of 65 with at least one risk factor for falling (recent previous fall or fear of falling). Letter sent to patient's General Practitioner if they scored 10 points or above on the 15-item Geriatric Depression Scale (GDS-15) informing them of the patient's risk of depression. GDS-15 score six months after initial completion of GDS-15. 895 (88.6%) of the 1010 participants randomised into REFORM had a valid baseline and six-month GDS-15 score and were included in this study. The mean GDS-15 baseline score was 3.5 (SD 3.0, median 3.0, range 0-15); 639 (71.4%) scored 0-4, 204 (22.8%) scored 5-9 indicating mild depression, and 52 (5.8%) scored 10 or higher indicating severe depression. At six months follow-up, those scoring 10 points or higher at baseline had, on average, a reduction of 1.08 points on the GDS-15 scale (95% confidence interval -1.83 to -0.33, p = 0.005) compared to those scoring less than 10, using the simplest linear regression model. Case finding of depression in podiatry patients based on a GDS-15 score of 10 or more followed by a letter to their General Practitioner significantly reduced depression severity. Whether this applies to all older patients in primary care is unknown. Further research is required to confirm these findings. Regression discontinuity analyses could be prespecified and embedded within other existing research studies.

Occupational Risks of Podologists: A Combined Assessment of VOCs, Vibration, Noise Levels and Health Complaints

ABSTRACT Podologists are exposed to many occupational hazards, including volatile organic compounds (VOCs) from insole manufacturing and noise/vibration during nail or tissue grinding. In this study, VOCs, noise, and vibration were measured in five podiatry clinics and three offices. Questionnaires were administered to 23 podologists and 19 office workers to inquire about their pain, ocular, skin and respiratory complaints. The results showed that the podologists’ exposure to the total VOC concentrations was approximately twice as high as that of the office workers. The podologists’ complaints regarding pain were found to be correlated with ambient noise and hand-arm vibration levels. Ocular, skin, and respiratory complaints were also found to be correlated with total VOC concentrations. These results suggest that VOCs, noise and vibration in the working environment may impair podologists’ health and that they have an intensifying effect on each other, increasing the severity of health issues.

The importance of asking about wellbeing in a diabetes foot clinic

AbstractThe onset of diabetes foot complications signals a new stage of diabetes progression. Amputation may be the result of such difficulties and can impact upon all aspects of a person's life such as mobility, independence, relationships, and possible loss of earning potential, all likely triggers of distress.The aim of this article is for a health care professional to understand more about the types of distress experienced by individuals with diabetes. It will consider whether routine screening could help diabetes podiatry teams improve the outcomes of their patients.Living with a long‐term condition such as diabetes can be stressful due to increased self‐management responsibilities and the potential for long‐term complications. Diabetes can interact with a person's mental health, including depression or anxiety.The concept of diabetes distress describes the emotional distress resulting from living with diabetes and the burden of relentless daily self‐management. As this type of distress is relatively common, and impacts upon self‐care, it is important that every consultation includes a chance for a person living with diabetes to say how they are feeling.Screening is one way a team can easily identify diabetes distress and provides the opportunity to discuss how each individual is coping with diabetes and life generally.A routine brief screening measure such as the two‐item Diabetes Distress Screening instrument (DDS2) can be quickly and easily administered by health care professionals within a busy diabetes podiatry clinic and helps initiate an all‐important conversation about wellbeing. Copyright © 2023 John Wiley &amp; Sons.

Use of disposable negative pressure wound therapy in 16 podiatry clinic patients with chronic wounds

BACKGROUND: Disposable mechanical negative pressure wound therapy (dNPWT) can help manage lower extremity wounds in the outpatient clinic. PURPOSE: We assessed dNPWT use in 16 patients at a podiatry clinic. METHODS: Patients were treated between October 31, 2019 and December 16, 2021. All patients received dNPWT with dressing changes every 2 to 3 days. Demographics, baseline wound and subsequent wound visit data, and treatments were recorded. Wound healing outcomes were assessed. RESULTS: Average patient age was 59.6 ± 8.9 years old. Patient comorbidities included poor nutritional status, diabetes, and hypertension. Wound types consisted of 6 diabetic foot ulcers, 9 surgical wounds, and 1 pressure injury. At baseline, the average wound age was 15.6 weeks, average area was 5.5 cm2, and average volume was 3.3 cm3. The average time from presentation to end of dNPWT was 45.5 days. In this timeframe, wounds improved in granulation tissue amount (81%), reduced in area (63%), and reduced in volume (69%). By the end of treatment, a majority of patients (88%) displayed 76% to 100% wound bed coverage with healthy granulation tissue. The remaining 12% showed &lt;76% coverage with granulation tissue. CONCLUSIONS: In this retrospective study, 14 of 16 patients displayed improvement in wound area, volume, and granulation tissue amount during dNPWT treatment.

Depression in Patients with Peripheral Artery Disease: An Underdiagnosis with Increased Mortality

Among patients with peripheral artery disease (PAD), depression is diagnosed in 17-25% and negatively impacts wound healing, quality of life, and survival. We hypothesized that depression is underdiagnosed in patients with PAD. Additionally, given the associations between depression and mortality in PAD patients, there is an increased need to investigate the strength of this relationship. The present analysis includes 2 studies to address the following aims: (1) Investigation of the prevalence of concomitant PAD and depression in a cohort from the Southeastern United States, and (2) Examination of the association between depression and all-cause mortality in a cohort of Canadian patients with PAD. STUDY 1: From June-August 2022, the Patient Health Questionnaire Module 9 (PHQ-9) was administered to all patients seeking PAD-related care including medical, wound/podiatric, or vascular interventional/surgical treatment, in the University of North Carolina-Chapel Hill Vascular, Wound, and Podiatry clinics. The PHQ-9 assesses symptoms over 2weeks and is scored 0-27, with higher scores indicating increasingly severe depression. Demographics, primary diagnosis, depression history, and antidepressant prescription were determined through chart review. We compared the proportion of positive depression screenings (PHQ-9≥5) to known depression. Among those treated for depression, the PHQ-9 score severity was evaluated. T-tests and χ2 tests were used to compare means and proportions. STUDY 2: From July 2015 to October 2016, the Geriatric Depression Scale Short Form was administered to adult patients with PAD undergoing revascularization. The Geriatric Depression Scale Short Form is a self-report measure of depression with a score >5 consistent with depression. The prevalence of depression was determined; primary outcome was all-cause mortality at 6months. STUDY 1: In 104 PAD patients (mean age 66.6±11.3years, 37% female), 37% of respondents scored ≥5 on the PHQ-9 survey, indicating at least mild depression. Only 18% of PAD patients had a history of depression, demonstrating a significant difference between the PHQ-9 findings and documented medical history. While depression was underdiagnosed in both men and women, men were more likely to have unrecognized depression (chi-squared statistic=35.117, df=1, P<0.001). Among those with a history of depression, 74% had a current prescription for antidepressant medication, but 57% still had an elevated PHQ-9 score indicating possible undertreatment. STUDY 2: In 148 patients (mean age 70.3±11.0years, 39% female) the prevalence of screened depression was 28.4%, but only 3.3% had a documented history of depression suggesting significant underdiagnosis. Patients with depression were significantly more likely to die within 6months of revascularization (9.5% vs. 0.9%; odds ratio 1.48, 95% confidence interval: 1.08 to 2.29). There was no association between depression and risk of length of stay, reintervention, or readmission. Depression is underdiagnosed and undertreated among patients with PAD, which has grave consequences as it is associated with 1.5 times the odds of mortality within 6months of revascularization. There is a critical need for more robust screenings and comprehensive mental health treatment for patients with concomitant depression and PAD.

The experiences of health workers using telehealth services for diabetes-related foot complications: a qualitative exploration

BackgroundDiabetes-related foot disease (DFD) accounts for up to 75% of lower-extremity amputations globally. Rural and remote communities are disproportionately affected by DFD. Telehealth has been advocated as a strategy to improve equity of access to health care in rural and remote communities. Current literature suggests that successful implementation of telehealth requires access to adequate reliable equipment, staff training, and support. A real-time video-based telehealth foot service (TFS) for delivering DFD management has recently been established in a Vascular Surgery and Podiatry clinic within a large South Australian metropolitan hospital. The purpose of this study was to gain insights into the experiences of rural and remote health professionals utilising the TFS, as this could be invaluable in optimising the uptake of telehealth use in DFD.MethodsThis exploratory, descriptive qualitative study employed one-on-one, semi-structured interviews with health professionals who utilised the service. Thematic analysis using an essentialist inductive approach was employed.ResultsParticipants included 14 rural and remote health professionals; 2 general practitioners, 2 nurses, 1 Aboriginal Health Practitioner, and 9 podiatrists. In addition, 2 metropolitan-based TFS staff were interviewed. Five key themes were identified. ‘Patients have reduced travel burden’ included that telehealth enabled Indigenous patients to stay on country. ‘Patients had increased psychosocial support’ covered the benefits of having health professionals who knew the patient present in consults. ‘Improved access’ incorporated how telehealth improved interprofessional relationship building and communication.‘Technological and equipment challenges’ highlighted that poor network connectivity and poor access to equipment to conduct telehealth consults in rural areas were barriers. The last theme,’Lack of service communication to rural health professionals’, highlighted the need for communication around service details.ConclusionTelehealth is a valuable tool that can improve access to treatment for rural and remote Indigenous DFD patients. While this has the potential to improve DFD outcomes, empirical data is required to confirm outcomes. Considering the advantages of telehealth and rural staff shortages, there is an urgent need for investment in improved equipment and processes and an understanding of the training needs of the health care workforce to support the use of telehealth in DFD management.

Prevalence and Characteristics of Fibromyalgia in Patients with Foot and Ankle Pain: The Experience of an Academic Podiatry Clinic

Background and Objectives: Research about the prevalence of fibromyalgia in podiatric patients is limited, with data suggesting potentially higher estimates and greater foot impairment in patients with fibromyalgia compared to healthy individuals. The aim of our study is to assess the prevalence of fibromyalgia in the podiatric healthcare setting and to research the characteristics of fibromyalgia patients with foot or ankle disorders. Materials and Methods: Consecutive patients visiting the academic podiatry clinic at the University of Bologna IRCCS Rizzoli Orthopaedic Institute between 11 January and 31 March 2021 were enrolled. Results: Of the 151 patients included, 21 met the fibromyalgia survey diagnostic criteria, accounting for a prevalence of 13.9% (95% CI 8.8-20.5). As part of the podiatric assessment, the Foot Function Index (FFI) was used to calculate the impact of foot and ankle problems. Moreover, patients with fibromyalgia were asked to complete the fibromyalgia impact questionnaire (FIQ). Fibromyalgia patients had significantly worse total FFI scores (63.4 ± 23.0% vs. 53.2 ± 20.3%, p = 0.038) and there was a significant linear correlation between the FFI and the FIQ (r = 0.72, p < 0.001). Conclusions: The prevalence of fibromyalgia in the academic podiatry clinic being 13.9% confirms that, in the healthcare setting, the disease can be more frequent than in the general population. Furthermore, our findings suggest a strong correlation between foot impairment and the impact of fibromyalgia.

Footwear and insole design parameters to prevent occurrence and recurrence of neuropathic plantar forefoot ulcers in patients with diabetes: a series of N-of-1 trial study protocol

BackgroundFoot complications occur in conjunction with poorly controlled diabetes. Plantar forefoot ulceration contributes to partial amputation in unstable diabetics, and the risk increases with concomitant neuropathy. Reducing peak plantar forefoot pressure reduces ulcer occurrence and recurrence. Footwear and insoles are used to offload the neuropathic foot, but the success of offloading is dependent on patient adherence. This study aims to determine which design and modification features of footwear and insoles improve forefoot plantar pressure offloading and adherence in people with diabetes and neuropathy.MethodsThis study, involving a series of N-of-1 trials, included 21 participants who had a history of neuropathic plantar forefoot ulcers. Participants were recruited from two public hospitals and one private podiatry clinic in Sydney, New South Wales, Australia. This trial is non-randomised and unblinded. Participants will be recruited from three sites, including two high-risk foot services and a private podiatry clinic in Sydney, Australia. Mobilemat™ and F-Scan® plantar pressure mapping systems by TekScan® (Boston, USA) will be used to measure barefoot and in-shoe plantar pressures. Participants’ self-reports will be used to quantify the wearing period over a certain period of between 2 and 4 weeks during the trial. Participant preference toward footwear, insole design and quality-of-life-related information will be collected and analysed. The descriptive and inferential statistical analyses will be performed using IBM SPSS Statistics (version 27). And the software NVivo (version 12) will be utilised for the qualitative data analysis.DiscussionThis is the first trial assessing footwear and insole interventions in people with diabetes by using a series of N-of-1 trials. Reporting self-declared wearing periods and participants’ preferences on footwear style and aesthetics are the important approaches for this trial. Patient-centric device designs are the key to therapeutic outcomes, and this study is designed with that strategy in mind.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000699965p. Registered on June 23, 2020

1742. Antibiotic Use in the Podiatry Clinic: Antimicrobial Stewardship Setting Foot in Uncharted Territory

Abstract Background Podiatrists independently manage diabetic foot ulcers (DFU), often complicated by diabetic foot infections (DFIs). The prevalence of DFU is 40 - 60% and guidelines vary in their recommendations for DFI, creating a target for antimicrobial stewardship. However, the prevalence and appropriateness of antibiotics prescribed by podiatrists has not been reported. We describe both variables among patients with DFU in a podiatry clinic. Methods We conducted a retrospective chart review of all consecutive patients &amp;gt; 18 years of age with DFUs, infected or not, who had at least one visit to the UPMC Mercy Wound Clinic (Pittsburgh, PA) in 2020. We defined severity of infection using the PEDIS score and diagnosis of osteomyelitis (OM) (Figure 1). We collected data on antibiotics prescribed by podiatry in the clinic or by any provider during a hospitalization for DFI. Figure 2 shows our appropriateness criteria. Figure 1:Stratification of Severity of Diabetic Foot InfectionFigure 2:Criteria for Appropriateness of Antibiotic Use in Diabetic Foot Ulcers Results Of 72 patients with DFU, 32 (44.4%) received an antibiotic. Compared to those who did not receive antibiotics, patients who did were more likely male (86.2% vs. 63.6%), had a higher PEDIS score (2.03 vs. 1.49), and were more frequently diagnosed with OM (71.9% vs. 26.8%). (Table 1). Table 2 shows the most common antibiotics. Among the five patients with no to mild infection, none received appropriate treatment (Table 3). Two patients in that category received IV antibiotics (when hospitalized for DFI), and neither received an Infectious Diseases (ID) consult. The other three were considered inappropriate due to durations &amp;gt; 7 days. The mean length of treatment for patients with mild infection was 12.6 (4.56). The two patients with moderate infection who received antibiotics had “inappropriate” courses; however, both had complicated Staphylococcus aureus bacteremia, and therefore 4-6 weeks courses were justified. All 12 inappropriate courses in severe infections were due to courses &amp;gt; 42 days. Conclusion Prescription of antibiotics among patients with DFU was common. Our findings suggest potential targets for antimicrobial stewardship: unnecessarily long courses an IV antibiotic use in patients with mild or no infection. Our criteria can be refined to recognize situations in which prolonged therapy may be justified, and larger studies are warranted. Disclosures All Authors: No reported disclosures.

Case studies 1-3: leg ulcers.

Case studies are presented here by a tissue viability nurse consultant and an advanced podiatrist demonstrating the use of ChloraSolv in clinical practice. The first set of cases is from a community setting, where the tissue viability nurse and district nurse successfully used the product to fully debride hard-to-heal leg ulcers in patients who mostly had been unable to tolerate other forms of debridement. The second set illustrates its use in a podiatry clinic, where the gel removed dry, adherent slough. 'These case studies show that ChloraSolv can be used by any health professional to achieve a clean wound bed'.

P086 Patient perceptions of musculoskeletal ultrasound as an educational tool in a rheumatology podiatry clinic

Abstract Background/Aims Emerging evidence suggests musculoskeletal ultrasound (MSUS) may benefit patient understanding of their inflammatory arthritis and medication adherence. The overall objective was to explore patient perceptions of MSUS when used as a patient education tool in relation to foot problems in people with rheumatic and musculoskeletal diseases (RMD). Methods Consecutive patients attending a rheumatology podiatry clinic at the Queen Elizabeth University Hospital Podiatry Department, Glasgow, were invited to participate. To gather information on how useful MSUS was for patient understanding of their foot problems, participants completed a brief questionnaire before and after their MSUS scan. MSUS assessment of affected foot structures was conducted by a single podiatrist with MSUS training (LN) using an Esaote MyLabAlpha portable US machine. Participants were shown both grayscale and power Doppler MSUS still images with/without video clips and caliper measurements depending on the presenting complaint. Anatomical foot models were used to orientate patients to foot anatomy and corresponding MSUS images. Results A total of 43 (12 male: 31 female) participants were recruited with a mean (SD) age of 50 (12) years and median disease duration (IQR) of 6 (1,10) years. The most common RMD was spondylarthopathy (30%) followed by RA (23%). In this group, the rearfoot region (35%) was most frequently involved. The most frequently affected structure was tendons (30%) with multiple structures affected in 19%. A range of mechanical and inflammatory MSUS diagnoses were made. 56% of participants had not previously seen MSUS of the joints or tendons, with the remaining 44% unsure. 93% reported the MSUS scan improved understanding of their foot pain and 98% reported it will make them more likely to adhere to podiatry treatments and advice [Table 1]. 98% also reported that MSUS was more useful than other educational resources for understanding their foot pain. Still images were selected most frequently as the method that made the most sense to participants. Conclusion This study provides preliminary evidence of the potential value of MSUS as an educational tool in podiatry, with potential to enhance adherence with podiatry interventions and rehabilitation programmes. Further work using a follow up design is required. Disclosure L. Newcombe: None. J. Tougher: None. N. Kelleher: None. J. Woodburn: None. R. Barn: None.

Good Clinical Outcomes Following Minor Foot Amputations in People with Diabetes: A Retrospective Clinical Audit of Associated Factors

Abstract Background: The purpose of this retrospective audit was to compare patient based clinical outcomes to amputation healing outcomes twelve months after a minor foot amputation in people with diabetes. Methods: Hospital admission and community outpatient data were extracted for all minor foot amputations in people with diabetes in 2017 in the Central Coast Local Health District. Results: A total 85 minor foot amputations involving 74 people were identified. At the twelve-month follow-up 74% (n=56) of the minor foot amputations healed, 63% (n=41) of the participants achieved a good clinical outcome (healed, no more proximal amputations, or death within the 12 month follow up period), and the mortality rate was 18%. Poor clinical outcomes were associated with those aged greater than 60 (RR 5.75, 95% CI: 0.85 to 38.7, p=0.013), those undergoing a further surgical debridement procedure during their hospital stay (RR 2.42, 95% CI: 1.3 to 4.4, p=0.005) and those who did not attend CCLHD Podiatry clinics post-amputation (RR 2.3, 95% CI: 1.2 to 4.1, p=0.010). Conclusions: To improve patient based clinical outcomes post-minor foot amputation, targeted follow-up in a high-risk foot clinic, and tailored discharge treatment plans for people aged over 60 or those undergoing a debridement procedure may be considered.

An evaluation of podiatry service use for people with inflammatory rheumatic diseases: a review of a rheumatology podiatry clinic in Aotearoa New Zealand

BackgroundFoot problems, including foot pain, structural deformities, skin and nail lesions, and footwear difficulties, are common in people with inflammatory rheumatic diseases. However, dedicated podiatry services are limited, including in Aotearoa New Zealand. This study aimed to evaluate the podiatry service use for people with inflammatory rheumatic diseases who attended a specialist podiatric rheumatology clinic in Aotearoa New Zealand.MethodsThis retrospective review included people with an inflammatory rheumatic disease who attended the Auckland University of Technology Podiatric Rheumatology Clinic between 2010 and 2021. Data were extracted manually from patients’ clinical records, including variables relating to patient characteristics, appointment details, presenting complaint, assessments performed, and treatments provided.ResultsFrom 2010 to 2021, 157 people with inflammatory rheumatic diseases attended 1570 appointments. The most common presenting concern was foot pain (reported by n = 121, 77.1% patients during at least one appointment), followed by skin/nail lesions (n = 98, 62.4%) and footwear/orthotic needs (n = 90, 57.3%). A range of podiatric interventions were provided to address foot-care needs, in which education (n = 151, 96.2%) and general skin/nail care (n = 107, 68.2%) were the most common treatments provided. The majority of patients also received footwear interventions at some point during their period of service provision (n = 96, 61.1%), followed by orthoses, other padding/offloading devices, wound care, exercise prescription and referrals to other health professionals.ConclusionsThis is the first study to review podiatric service provision for people with inflammatory rheumatic diseases attending a specialist podiatric rheumatology clinic in Aotearoa New Zealand. The results of this study have shown that a podiatry clinic dedicated to people with inflammatory rheumatic diseases addresses the wide range of foot problems through an extensive provision of treatment services.

Investigating the experience of receiving podiatry care in a tertiary care hospital clinic for people with diabetes related foot ulcers

BackgroundDiabetes related foot ulcers can have physical, social, emotional, and financial impacts on the daily life and wellbeing of many people living with diabetes. Effective treatment of diabetes related foot ulcers requires a multi-faceted, multi-disciplinary approach involving a podiatrist, other healthcare professionals, and the person with diabetes however, limited research has been conducted on the lived experience of podiatric treatment for diabetes related foot ulcers to understand how people are engaged in their ulcer management. Therefore, this study aimed to explore the lived experience of receiving podiatric treatment for diabetes related foot ulcers in a tertiary care outpatient setting.MethodsTen participants were interviewed. All were male, with mean age of 69 (SD 15) years and currently undergoing podiatric treatment for a diabetes related foot ulcer in a tertiary care setting. Participants with diabetes related foot ulcers were purposively recruited from the outpatient podiatry clinic at a tertiary hospital in a metropolitan region of South Australia. Semi-structured interviews were conducted to gain insight into the lived experience of people receiving podiatric treatment for their foot ulcer and understand how this experience impacts their regular lifestyle. Data were analysed using a thematic analysis method.ResultsFour themes were identified that add an understanding of the lived experience of participants: ‘Trusting the podiatrists with the right expertise’, ‘Personalised care’, ‘Happy with the service, but not always with prescribed care’, and ‘It’s a long journey’. Participants described professional behaviour including high organisation and hygiene practices and demonstrated expertise as key factors influencing their trust of a podiatrist’s care. Information tailored to individual needs was helpful for participants. Offloading devices and ulcer dressings were often burdensome. Podiatric treatment for foot ulcers was a lengthy and onerous experience for all participants.ConclusionsThe findings of this study suggest podiatrists can use practical strategies of maintaining consistency in who provides podiatry care for the person, demonstration of high organisational and hygiene standards, and using innovation to adapt information and equipment to suit an individual’s lifestyle to support positive experiences of podiatric ulcer care. There is a need for further research to understand how a person’s experience of podiatric ulcer care differs amongst genders, cultural groups, and healthcare settings to facilitate positive care experiences and reduce treatment burden for all people with diabetes requiring podiatric ulcer treatment.

Superficial Tissue Swabs Versus Deep Tissue Samples in the Detection of Microbiological Profile of Infected Diabetic Foot Ulcerations.

This study aimed to determine the most accurate microbiological test for the detection of micro-organisms in infected diabetic foot ulcerations in people living with type-2 Diabetes. For 20 eligible patients, a superficial tissue swab and a deep tissue sample were taken during a regular appointment at a Diabetes out-patient's Podiatry Clinic. Two specimens were collected from each wound for microbial culturing after debridement. Infected foot ulcerations were graded according to the Wagner's classification as per clinical protocol. This study found a significant difference [p = 0.028] between the two different samples. The deep tissue sample was found to be more accurate in identifying micro-organisms than the superficial swabs, although the latter is more widely used in clinical practice. Further studies are warranted to provide more evidence to clinicians on the best method to adopt when swabbing different types of diabetic foot ulcerations with different wound classification since, it is clearly still a matter of debate how to detect wound infection.

845 Diabetic Foot Care Services in COVID-19 Era – A University Hospital Multi specialty Team Experience

IntroductionMultidisciplinary foot care services contribute to the reduction in amputations from foot ulceration secondary to diabetes. The COVID-19 pandemic pressurised services and required a pause of elective care. This study reports the patient’s experience of foot care provision during the first wave where self-care, virtual appointments and patient directed appointments were utilised.MethodDiabetic foot patients were retrospectively identified over a one-month period booked for MDT care (in hospital, OPD, diabetic foot clinic, community podiatry clinic or at home). All patients>16 years of age diagnosed with a new or previous diabetic foot ulcer or post-operative foot wound were included. Data was collated via a patient survey form and descriptive statistics were used to characterize the study population and responses.Results63 patients were identified (1/10 – 30/10) with data collated from 51 respondents (81%). 78% (40/51) were male. Median age was 69 years (IQR 59–76). 86% were comfortable attending a hospital appointment. 92% reported continuing to receive an appropriate level of care. All of the patients felt well supported and knew how to access the foot care service. 29% utilised virtual care. 82% (42/51) considered face to face appointments were more suitable for follow up rather than virtual/phone appointments.ConclusionsIt was possible to continue to provide safe diabetic foot care despite the COVID-19 pandemic but careful patient selection and communication is the key.

Does the Type of Surgical Technique and the Use of Prophylactic Antibiotics Affect the Clinical Results in Symptomatic Ingrown Toenail Patients?

Ingrown toenails are a common reason for referral to orthopedics and podiatry clinics. Recurrence and infection are common complications in ingrown toenail surgery. This study investigates the effect of an electrocautery matrixectomy on the recurrence and clinical outcomes in the Winograd technique applied in ingrown toenail surgery and whether prophylactic antibiotic use is necessary for these surgeries. One hundred forty-three patients who underwent surgery for ingrown toenails were analyzed retrospectively. Eighty-two patients underwent the Winograd procedure with electrocautery matrixectomy, whereas 61 patients underwent the Winograd procedure. While 78 patients were given prophylactic antibiotics, 65 patients were not. Patient satisfaction was evaluated with a surgical satisfaction questionnaire (SSQ). A visual analog score was used to evaluate the pain. Recurrence was observed in 3 toenails in the Winograd and electrocautery groups, while recurrence was observed in 9 toenails in the Winograd group (P = .018). In both groups, there was no statistically significant difference between the infection rates between patients who took antibiotics and those who did not (P > .05). There was no statistically significant difference between the groups in terms of SSQ scores (P > .05). It was observed that the surgery performed had a positive effect on pain, and this effect was statistically highly significant in both groups (P < .05). The outcomes of the present study suggest that the addition of an electrocautery matrixectomy to the Winograd technique in the surgical treatment of symptomatic Ingrown toenails may decrease recurrence rates. Additionally, this study showed that oral antibiotics, when used in addition to Ingrown toenail surgery, do not reduce postoperative morbidity.