Poor Foot Research Articles

Foot Care Knowledge and Practice among Diabetic Patients Attending General Outpatient Clinic in Tribhuvan University Teaching Hospital

Background: Diabetes Mellitus results in several serious complications and among them foot problem is one of the commonly ignored complications. This study is an attempt to find out the level of patient’s awareness and practice in Nepalese context. Objective: The aim of this study is to determine the knowledge and practice of foot care among patients with diabetes in Nepal. Methods: This is a six-month long cross-sectional study done in the General Practice Clinic of Tribhuvan University Teaching Hospital. Diabetic patients were given structure questionnaires on knowledge, foot care practices, and demographic information. Results: Illiteracy was found be significantly associated with poor knowledge and practice of foot care. Those who have no education are more likely to have poor knowledge and foot care practice. The odds of having poor knowledge is 6.414 (3.075, 13.379) in those who have no education/primary education compared to those who have education and the odds of poor foot care practice is 4.5180 (2.077, 8.411) in those who have no education/primary education compared to those who have education with significance of <0.001. Conclusion: This study has highlighted the need of appropriate education intervention for the patients with diabetes who have no education background to prevent from foot complications. Health education materials such as graphics, photos are needed to make them comprehensible for the illiterate patients.

Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study.

Diabetes mellitus is a metabolic disorder which is characterized by multiple long-term complications that affect almost every system in the body. Foot ulcers are one of the main complications of diabetes mellitus. However, there is limited evidence on the occurrence of foot ulcer and influencing factors in Ethiopia. An institutional-based cross-sectional study was conducted in Gondar University Hospital, Ethiopia, to investigate foot ulcer occurrence in diabetic patients. Systematic random sampling was used to select 279 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. Odds ratio with 95% confidence interval was computed to determine the level of significance. Diabetic foot ulcer was found to be 13.6%. Rural residence [AOR = 2.57; 95% CI: 1.42, 5.93], type II diabetes mellitus [AOR = 2.58; 95% CI: 1.22, 6.45], overweight [AOR = 2.12; 95% CI: 1.15, 3.10], obesity [AOR = 2.65; 95% CI: 1.25, 5.83], poor foot self-care practice [AOR = 2.52; 95% CI: 1.21, 6.53], and neuropathy [AOR = 21.76; 95% CI: 8.43, 57.47] were factors associated with diabetic foot ulcer. Diabetic foot ulcer was found to be high. Provision of special emphasis for rural residence, decreasing excessive weight gain, managing neuropathy, and promoting foot self-care practice would decrease diabetic foot ulcer.

Achilles tendon injury in kendo players in junior and senior high schools: with a focus on foot function.

[Purpose] We investigated Achilles tendon injury in Kendo players in junior and senior high schools to obtain a possible indicator for preventing an outbreak of Achilles tendon injury and tendonitis, possible risk factors concerning foot function and morphology were extracted. [Subjects and Methods] The subjects were 60 Kendo players aged 14–18 years from Wakayama Prefecture, Japan (33 boys and 27 girls). A questionnaire survey was conducted on the past history, current status, time of occurrence about Achilles tendon pain or rupture, and site of Achilles tendon pain or rupture. Based on the responses to the questionnaire, these students were divided into two groups, i.e., those who had a history of Achilles tendon pain (n=30) or rupture (n=3) (pain group) and those who had no history of Achilles tendon pain (no-pain group), and they were examined for foot alignment, flexion and extension Range of motion test of the first toe, flexion and extension muscle strength of the first toe, and opening movement of the toes. [Results] Achilles tendon pain had occurred in 53% of the Kendo players (including 3 who had suffered Achilles tendon rupture). Poor foot alignment and deterioration of opening movement of the toes were noted in the pain group. [Conclusion] Foot alignment was poor and opening function of the toes deteriorated in the pain group, suggesting that these may be some of factors for Achilles tendon injury. Training aimed at improving foot alignment and function is important to prevent and improve Achilles tendon injury.

Knowledge evaluation and educating diabetic patients on self foot care at diabetic out patients` clinic, Muhimbili National Hospital

Background: Diabetic foot infection, ulcers and amputations remain very common in diabetics worldwide and extremely affect patients’ quality of life. The objective of this survey was to assess the level of knowledge and educate diabetic patients on self foot care at diabetic outpatient clinic at Muhimbili National Hospital Methods: A cross-sectional survey of diabetic patients was conducted at Muhimbili National Hospital at the diabetic outpatient clinic from mid September to mid November 2013 inclusive. Patients who voluntarily consented and determined fit for the study were recruited. Data on subjects` demographic characteristics and status of baseline and post discussion sessions self foot care knowledge were collected and analysed. Results: A total of 115 patients were studied. Females were the majority 60.9% (70) and the mean age was 33.5(SD± 1.8) years, age ranged from 11years to 65 years. A considerable number of patients had poor self foot care knowledge 54(47.0%).Young patients (<30 years) had better knowledge about self foot care. There was a parallel increase in knowledge level of foot care with increasing level of education (P value =0.000). There was a significant improvement in self foot care knowledge level score among participants after foot care education sessions as the mean knowledge score prior education and post education were 5.7(SD±3.6) and 15.6(SD2±.5) respectively (P value = 0.000). Conclusion and recommendation: A considerable number of diabetic patients have poor self foot care knowledge and the level of knowledge on self foot care improved prominently following foot care education session. Therefore there is a need for establishment and strengthening effective foot care education for diabetic patients at clinics in order to prevent and reduce the incidence of foot infection, ulceration and amputations. Keywords: Diabetic patients, Self foot care knowledge, Self foot care education, Diabetic foot complications

Long-term outcomes of hallux valgus treated by the suturing of fascial flap of bursa of hallux with the tendon of adductor hallucis

Objective To evaluate the long-term clinical effect of adductor pollicis and pollicis sac fascial flap anastomosis for hallux valgus. Methods Data 12 cases with hallux valgus who who were treated by adductor pollicis and pollicis sac fascial flap anastomosis from April 1993 to November 1996 and were followed up for more than 19 years were retrospectively analyzed. All the patients were female with an average age of 43.6±7.6 years old (range, 24-56 years). HVA, IMA, and tibial sesamoid position (TSP) were measured by foot X-ray and compared between presurgery, 4 years postsurgery and 19 years postsurgery. The American Orthopaedic Foot and Ankle Society (AOFAS), hallux metatarsophalangeal joints, interphalangeal joint function scores were used to evaluatethe foot function. Patient satisfactions were investigated by Glynn's comprehensive clinical evaluation and hallux score. Results Average preoperative HVA was 30.68°±9.71°, and average 1st and 2nd IMA was 12.92°±4.02°. Average HVA 4 years and 19 years post-op were 24.62°±7.61° and 21.47°±6.52°, and average 1st and 2nd IMA were 7.32°±3.21° and 6.15°±2.92°, which were significantly less than those of pre-surgery. Average TSP was 4.46±1.03, average TSP 4 years and 19 years post-op were 2.01±0.75 and 1.79±0.62, which were significantly less than those of pre-surgery. There was no significant difference between 4 years and 19 years post-op. The incidence of plantar anterior callus was 95.2% (20/21); the incidence of pain was 85.7% (18/21), and the number of the corpus callosum was significantly reduced 19 year post-op. Only 1 foot had painful callus under the head of third metatarsal, and the rest of the corpus callosum were painless; the incidence of the corpus callosum was 33.3% (7/21); the incidence of pain of the corpus callosum was 4.7% (1/21); the incidence of pain of the corpus callosum was 4.7%, and patients with long-term improvement of the effect of the corpus callosum was significantly better than preoperative. The results of postoperative follow-up Glynn comprehensive clinical evaluation were 16 excellent feet, 2 good feet, 3 poor feet, and the excellent rate was 88.5% (18/21); the results of Glynn toe evaluation were 18 excellent feet, 3 good feet, and the excellent rate was 100%. Conclusion The adductor pollicis and pollicis sac fascial flap anastomosis in the treatment of hallux valgus can obtain good short-term and long-term clinical efficacy, by which postoperative hallux valgus deformity is excellently corrected, and the rate of patient satisfaction is high. Key words: Foot; Hallux valgus; Follow-up studies

Short communication: Association of foot and leg conformation and body weight with claw disorders in Spanish Holstein cows.

Data of first-lactation Holstein cows including claw disorders, foot and leg type traits, and structure and capacity type traits were used to study the phenotypic association of conformation and body weight with claw health status. The claw disorders studied were digital and interdigital dermatitis, sole ulcer, white line disease, and an overall claw disorder trait, indicating the presence of any of the 6 claw disorders recorded by the Spanish I-SAP program. Body weight was estimated indirectly with the Von Bertalanffy equation using live weight, which was also estimated from body depth, stature, and chest width. Cows with poor scores for foot and leg traits were more likely to have a claw disorder, with the exception of rear leg rear view and foot and leg composite that did not show any association with the studied disorders. The heavier the cow was, the higher was the probability of having sole ulcer, white line disease, or overall claw disorder trait, but digital and interdigital dermatitis, as an infectious disorder, did not show any association with body weight. Therefore, it is recommended that the preventive trimming routine be improved, which means checking each cow at least once per lactation and trimming if necessary, to achieve balanced weight-bearing for heavier cows and cows with poor feet and leg classification.

Factors Affecting Foot Self-Care Practices in Individuals with Diabetes Mellitus Living in an Asian Population - A Quantitative Study

Category: Diabetes Introduction/Purpose: Diabetic foot complications and subsequent lower limb amputations commonly occur in diabetic patients due to poor foot care. We aimed to understand the extent of proper footcare practices and to identify the factors which influence these among diabetic patients in a multi-ethnic Asian population. Methods: A cross-sectional multi-centre quantitative study was performed. Inclusion criteria was all patients attending hospital outpatients clinics for diabetes. Patients were only excluded if they were unable to understand basic English. Demographic information, medical history (including formal assessment for peripheral neuropathy) and Nottingham Assessment of Functional Footcare (NAFF) scoreswere collected. All data was analysed using SPSS Version 21. Results: 350 valid responses were obtained. The mean NAFF score was 49.6±7.19. Univariate analysis revealed that ethnically non-Chinese patients had significantly better scores than did Chinese patients. After linear regression analysis, a statistically significant correlation with better foot care practices was found for patients with higher education levels, active employment and the presence of previous diabetic foot complications. Conclusion: The mean NAFF scores in our study were lower than those published in other populations which may in part account for the huge burden of diabetic foot disease in Singapore. Patients appear to start to look after their feet better only after suffering a complication.Cultural and financial factors probably account for the differences in our risk factor findings and those published in other populations. Future studies should i evaluate the effectiveness of targeted interventions for the specific groups that we have identified who have poorer NAFF scores.

Foot dimensions and morphology in healthy weight, overweight and obese males

BackgroundOverweight and obesity are increasing in prevalence. However, despite reports of poor foot health, the influence of obesity and overweight on adult foot morphology has received limited attention. The objective of this work is to accurately and appropriately quantify the foot morphology of adults who are overweight and obese. MethodsThe foot morphology of 23 healthy weight (BMI=22.9kg.m−2), overweight (27.5kg.m−2) and obese (32.9kg.m−2) age (60years) matched males was quantified using a 3D scanner (all size UK 9). Data analysis computed normalised (to foot length) standard anatomical measures, and widths, heights and circumferences of 31 evenly spaced cross-sections of right feet. FindingsAnatomical measures of foot, ball and heel width, ball and heel circumference and ball height were all greater in the obese group than the healthy weight (P<0.05). Cross-sectional measures were significantly wider than the healthy group for the majority of measures from 14 to 67% (P=0.025–1.000) of heel-to-toe length. Also, the obese group had significantly higher midfoot regions (P=0.024–0.025). This increased foot height was not evident from anatomical measures, which were not sensitive enough to detect dimensional differences in this foot region. InterpretationFeet of obese adults differ from healthy and overweight individuals, notably they are wider. Data needs to avoid reliance upon discrete anatomical landmarks to describe foot morphology. In the obese, changes in foot shape do not coincide with traditional anatomical landmarks and more comprehensive foot shape data are required to inform footwear design.

Odnos posturalnog statusa stopala i eksplozivne snage nogu adolescenata / Relation Between the Postural Feet Status and Explosive Strength of Lower Extremities in Adolescents

The aim of this study was to determine the differences in the manifestation of explosive strength of legs and pelvis girdle regarding the degree of drooping medial arch of the feet and also according to gender differences. The research covered 90 respondents (45 males and 45 females), from the Secondary School Economics in Novi Sad, aged 15 ± 0.5. The status of the foot arch was determined by using the clinical method, and the explosive strength by motoric tests of standing long jump and triple jump. For identifying the differences, One-Factor Analysis of Variance was used, χ2 - test and Student t - test for independent samples, at the final degree of p≤0.00. Statistically significant differences were identified between the respondents with good and extremely poor foot status (p≤0.00) and the respondents with poor foot status (p≤0.000). Also, when it comes to gender, there were statistically significant differences in foot arch status and both motor tests (χ2=9.867; p≤0.007).

Reliability of metatarsophalangeal and ankle joint torque measurements by an innovative device

The toe flexor muscles maintain body balance during standing and provide push-off force during walking, running, and jumping. Additionally, they are important contributing structures to maintain normal foot function. Thus, weakness of these muscles may cause poor balance, inefficient locomotion and foot deformities. The quantification of metatarsophalangeal joint (MPJ) stiffness is valuable as it is considered as a confounding factor in toe flexor muscles function.MPJ and ankle joint stiffness measurement is still largely depended on manual skills as current devices do not have good control on alignment, angular joint speed and displacement during measurement.Therefore, this study introduces an innovative dynamometer and protocol procedures for MPJ and ankle Joint torque measurement with precise and reliable foot alignment, angular joint speed and displacement control. Within-day and between-day test-retest experiments on MPJ and ankle joint torque measurement were conducted on ten and nine healthy male subjects respectively. The mean peak torques of MPJ and ankle joint of between-day and within-day measurement were 1.50±0.38Nm/deg and 1.19±0.34Nm/deg. The corresponding torques of the ankle joint were 8.24±2.20Nm/deg and 7.90±3.18Nm/deg respectively. Intraclass-correlation coefficients (ICC) of averaged peak torque of both joints of between-day and within-day test-retest experiments were ranging from 0.91 to 0.96, indicating the innovative device is systematic and reliable for the measurements and can be used for multiple scientific and clinical purposes.

Mesenchymal stem cell therapy to promote limb transplant functional recovery.

Limb transplantation is a viable option for reconstruction after traumatic limb loss; however, functional recovery can be suboptimal. The aim of this study was to determine whether mesenchymal stem cell (MSC) administration can improve limb transplant functional recovery. Orthotopic syngeneic hindlimb transplants were performed in Lewis rats, followed by topical and intravenous injections of syngeneic MSCs (5 × 106 ) or vehicle. Transplanted limb sensory and motor functions were tested by cutaneous pain reaction and walking track analysis, respectively. MSCs expanded ex vivo were CD29+ , CD31- , CD34- , CD44+ , CD45low , CD90+ , MHC Class-I+ , Class-II- , and pluripotent. Greater than 90% of limb transplants survived. At 4 weeks post-transplantation, the mean sensory nerve (tibial, peroneal, or sural) function in MSC (n = 9) and vehicle (n = 9) groups was <0.3 on a scale of Grades 0-3 (0 = No function; 3 = Normal). By 8 weeks, the sensory scores for tibial, peroneal, and sural nerves were 2.2 ± 0.7, 1.2 ± 0.5, and 1.7 ± 0.9 in the vehicle, and 2.6 ± 0.4, 1.0 ± 0.9, and 1.7 ± 0.9 in the MSC group, respectively (n = 9/group). At 4, 8, 16, and 24 weeks, the overall sensory function was higher in MSC group (≥7/group). Sciatic Function Index (SFI), a measure of motor function, could not be calculated because of poor foot prints; therefore, a novel grading system was developed. Bone fusion/vascularization as determined by X-ray films/laser Doppler (≥2 week post-transplantation) were normal (n = 3/group). Gastrocnemius muscle was atrophied (P < 0.05), and flexion contractures were evident by 24 weeks. Bone marrow-derived MSC therapy appears to improve sensory function recovery in a rat limb transplant model. Published 2016. This article is a U.S. Government work and is in the public domain in the USA Microsurgery 37:222-234, 2017.

116 Results of a National Foot Health Survey of Patients with Systemic Lupus Erythematosus

Background: SLE can affect many tissues throughout the body. Anecdotally, it is suggested that people with SLE experience a range of complications in the foot and lower limb, including vascular impairment (e.g. RP), neurological impairment, poor tissue viability (e.g. ulceration), infection and foot pain. However, to date, the precise prevalence of foot complications experienced by people with SLE has not been described. The aim of this survey was to determine self-reported foot and lower limb complications experienced by people with SLE. Methods: The survey was developed via patient and practitioner focus groups. A consensus approach was used to generate items and to formulate themes, categories, question format and survey structure. The survey was checked for face and content validity prior to cognitive debriefing to ensure usability and understanding. Consecutive patients with a confirmed diagnosis of SLE meeting the inclusion criteria attending any of seven UK clinical sites or members of Lupus UK were invited to participate. Ethical approval and participant informed consent was obtained. Results: A total of 182 survey responses were completed. For all responders, the most frequent age range was 40–49 years, mean BMI was 27 (S.D. 7) and mean disease duration was 15 years (S.D. 10). A number of vascular complications were reported, including intermittent claudication [n ¼ 100 (55%)], RP [n ¼ 94 (52%)] and splinter haemorrhage [n ¼ 39 (21%)]. Overall, 164 patients (90%) reported experiencing symptoms of peripheral vascular complications. Symptoms of peripheral neuropathy were reported by 30 patients (16%), while a fall as a consequence of neuropathic symptoms was reported by 45 patients (25%). A range of skin and nail complications were reported, including callus or corns [n ¼ 130 (71%)], onychocryptosis [n ¼ 69 (38%)], rashes or blistering [n ¼ 62 (34%)] and ulceration [n ¼ 45 (25%)]. A high prevalence of infection was reported; a history of viral infection (verrucae pedis) or fungal infection (tinea pedis) was reported by 77 patients (42%), bacterial infection by 28 patients (15%) and onychomycosis by 65 patients (36%). Overall, 170 patients (93%) reported having experienced some form of tissue viability complication. Foot joint pain, stiffness and swelling was reported by 145 (80%), 136 (75%) and 94 (52%) patients, respectively. Foot-related walking impairment was reported by 67 patients (37%). Only 60 patients (33%) reported having ever been asked about their feet by a medical professional. Seventy-seven patients (42%) reported that they would benefit from the provision of general foot health care advice. Conclusion: A large number of people with SLE report vascular complications, impaired tissue viability, musculoskeletal problems and foot pain, as well as a range of infections and conditions of the skin and nails. Despite this, foot health assessment by professionals was infrequent. These results highlight the need to undertake clinical studies investigating lower limb pathologies in SLE.

Awareness and practice regarding foot self-care among patients of known type 2 diabetes mellitus in a rural area

Background: Diabetic foot problems accounts for about nearly 50% of diabetes related hospital admission. About 49-85% of all diabetic foot related problems are preventable if appropriate measures are taken. The objective of the study was to assess the awareness and practice towards foot self - care among patients of known type 2 diabetes mellitus in a rural area. Methods: The present study was conducted among patients with type 2 diabetes, attending Non-communicable disease (NCD) clinic, Rural Health Training Centre (RHTC), Sri Ramachandra University (SRU), Tamil Nadu, India. 31 participants gave written consent for their participation and they were interviewed using a questionnaire. Data entry and analysis was done using statistical package for Social Sciences (SPSS) 16 version software. Results: Mean age of participant was 54.5years. Regarding awareness, 64.5% were unaware that they need to give special attention to foot care, 77.4% were unaware that smoking causes poor circulation affecting the feet. Poor foot practices are; 67.7% do not check inside of footwear for objects before putting them on and 74.2% walk barefoot and 54.8% did not cut their toenails properly. Conclusions: Foot self-care awareness and practices among patients with diabetes were found to be poor. This implies an urgent need for health educating the patients which may prevent disability and reduce medical expenditure in long run.

IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes.

Recommendations To identify a person with diabetes at risk for foot ulceration, examine the feet annually to seek evidence for signs or symptoms of peripheral neuropathy and peripheral artery disease. (GRADE strength of recommendation: strong; Quality of evidence: low) In a person with diabetes who has peripheral neuropathy, screen for a history of foot ulceration or lower‐extremity amputation, peripheral artery disease, foot deformity, pre‐ulcerative signs on the foot, poor foot hygiene and ill‐fitting or inadequate footwear. (Strong; Low) Treat any pre‐ulcerative sign on the foot of a patient with diabetes. This includes removing callus, protecting blisters and draining when necessary, treating ingrown or thickened toe nails, treating haemorrhage when necessary and prescribing antifungal treatment for fungal infections. (Strong; Low) To protect their feet, instruct an at‐risk patient with diabetes not to walk barefoot, in socks only, or in thin‐soled standard slippers, whether at home or when outside. (Strong; Low) Instruct an at‐risk patient with diabetes to daily inspect their feet and the inside of their shoes, daily wash their feet (with careful drying particularly between the toes), avoid using chemical agents or plasters to remove callus or corns, use emollients to lubricate dry skin and cut toe nails straight across. (Weak; Low) Instruct an at‐risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non‐plantar, or a recurrent non‐plantar foot ulcer. When a foot deformity or a pre‐ulcerative sign is present, consider prescribing therapeutic shoes, custom‐made insoles or toe orthosis. (Strong; Low) To prevent a recurrent plantar foot ulcer in an at‐risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressure‐relieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) To prevent a first foot ulcer in an at‐risk patient with diabetes, provide education aimed at improving foot care knowledge and behaviour, as well as encouraging the patient to adhere to this foot care advice. (Weak; Low) To prevent a recurrent foot ulcer in an at‐risk patient with diabetes, provide integrated foot care, which includes professional foot treatment, adequate footwear and education. This should be repeated or re‐evaluated once every 1 to 3 months as necessary. (Strong; Low) Instruct a high‐risk patient with diabetes to monitor foot skin temperature at home to prevent a first or recurrent plantar foot ulcer. This aims at identifying the early signs of inflammation, followed by action taken by the patient and care provider to resolve the cause of inflammation. (Weak; Moderate) Consider digital flexor tenotomy to prevent a toe ulcer when conservative treatment fails in a high‐risk patient with diabetes, hammertoes and either a pre‐ulcerative sign or an ulcer on the distal toe. (Weak; Low) Consider Achilles tendon lengthening, joint arthroplasty, single or pan metatarsal head resection, or osteotomy to prevent a recurrent foot ulcer when conservative treatment fails in a high‐risk patient with diabetes and a plantar forefoot ulcer. (Weak; Low) Do not use a nerve decompression procedure in an effort to prevent a foot ulcer in an at‐risk patient with diabetes, in preference to accepted standards of good quality care. (Weak; Low)

A study of risk factors and foot care behavior among diabetics.

Background:Diabetic foot results in considerable morbidity and mortality in developing countries and the prevalence of diabetes is expected to increase further in the next decades in these countries. Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Patient education regarding foot hygiene, nail care and proper footwear is crucial to reducing the risk of an injury that can lead to ulcer formation.Materials and Methods:This is a prospective study carried out from July 2013 to September 2015. Fifty patients of Diabetes with foot ulcer and two hundred without foot ulcers were examined. Risk factors and clinical profile of patients were studied which included age, gender, duration of diabetes, BMI, smoking, random BSLs history, hypertension, glycated haemoglobin levels, lipid profile, history of loss of sensation and history of amputation. MNSI questionnaire and MNSI practical assessment for neuropathy were administered to diabetic patients along with a pre-structured questionnaire regarding foot care practices.Results:In this study significant risk factors were peripheral neuropathy, peripheral vascular disease, gender, loss of sensation, duration of diabetes and smoking. MNSI questionnaire and practical assessment scores were higher in foot ulcer patients. Poor foot care practices were observed in patients with diabetic foot ulcer patients.Conclusion:Diabetic foot ulcers were more common in elderly males. Peripheral neuropathy, peripheral vascular disease, Smoking, trauma, duration of diabetes mellitus and high levels of glycated haemoglobin had significant association with occurrence of foot ulcers. MNSI scores had a high predictive value for development of foot ulcers amongst diabetics. Awareness regarding foot care was poor which underlines need to promote practice of foot care amongst diabetic population.

Foot care practices of diabetic patients in Saudi Arabia.

Diabetic foot is a serious complication that causes lower extremity amputations. The aim of this study was to identify the patient’s awareness about risk factors for diabetic foot disease and to explore the knowledge and foot care practices among diabetic patients in a Saudi population. This cross-sectional study was conducted in King Khalid University Hospital (KKUH), King Abdulaziz University Hospital (KAUH), King Fahad Medical City, National Guard Hospital, Military Hospital, and Prince Salman Hospital capital city of Saudi Arabia. Patients were eligible if they had diabetes foot disease, signed the consent form, and completed the questionnaire. We selected 350 patients from different hospitals between November-2011 and April-2012. The majority of patients (68%) were selected from King Saud University hospitals. The mean age of patients was 50.87 ± 15.9 years with a range of 20–90 years. The majority of patients were male (64.3%) and had a family history of hypertension (55.4%), high total cholesterol (58.6%), and other diabetes (58.9%). A family history of smoking, a major risk factor for diabetic foot, was found in 20.3% of cases. Sixty percent of the patients were using oral medications, 27.1% were using insulin therapy, 10% were using both oral and insulin therapies, and 10% were on diet. In our study, 19.4% of participants were illiterate while 80.6% had a high school or university level education. Our findings also revealed that some patients had a lack of knowledge concerning diabetic foot disease and future complications. Patients are unaware of the risk factors for diabetes foot and practice poor foot care. Awareness programs should be mandatory in all hospitals and diabetes clinics to help compensate for the lack of awareness and lack of podiatric educational services. Such programs may decrease the risk of diabetes foot disease.

The incidence and prevention of foot problems among male Phase One British Army recruits at an Army Training Regiment

IntroductionStudies have demonstrated that there is an excessive number of foot problems among personnel entering the military, which leads to disruption to training resulting in an increase in both costs...

New NICE guidelines on diabetic foot disease prevention and management

With the rapid increase in the prevalence of diabetes, it is estimated that there will be 5 000 000 people with diabetes in the UK by 2025. Both the personal and the socioeconomic impact of diabetic foot disease is very significant and the cost estimate to the NHS in 2012 was around £600 million. The main thrust of NICE's new guidance document, NG19,1 on the prevention and management of diabetic foot disease, is around the importance of patient-centred care which is highlighted as 10 salient points in one main section. The document focuses in detail on the importance of prevention of foot ulceration and its active management, with key considerations regarding the diagnosis and management of Charcot arthropathy. The importance of patient review within 24 hours is once again highlighted, as is the need for having an established care pathway in all hospital and clinic settings. The patient should essentially be referred to the multidisciplinary foot team within 24 hours in order to provide best possible care; commissioners and service providers should also ensure that a diabetes multidisciplinary foot care service and robust protocols with clear pathways are available across all health care settings. There is still clearly an incongruity of services across different areas and this is highlighted by the clear-cut variance in amputation rate across the nation. The importance of close networking between diabetology and podiatry with biomechanics, tissue viability, diabetes specialist nursing, vascular and orthopaedic surgery, and interventional radiology is also highlighted. The document mentions the importance of easy access to patients with disability or who are housebound or living in the care of nursing homes. This is certainly of utmost significance because of the noticeable high prevalence of patients with poor mobility and diabetic foot disease. The importance of risk assessment is also highlighted, with risk stratification into low, moderate and high category levels. Patients at moderate risk should be referred to the foot protection service, whereas those with low risk should have annual assessment for neuropathy, ischaemia and foot deformity. On the other hand, patients with an active foot complication (high risk) should be immediately referred to the foot protection service or multidisciplinary foot care service within 24 hours of assessment so that individualised treatment can be provided acutely according to local protocol. One must remember that patients with active foot disease often have comorbidities such as cardiovascular disease, and this may need further investigation at the same time of assessment. Protocols for offloading, control of foot infection and management of ischaemia should all be in place. Certain therapies such as electrical stimulation therapy, growth factor treatment and hyperbaric oxygen therapy should not be offered as routine treatment unless part of a clinical trial. Monitoring of foot infections should include soft tissue and bone samples or superficial swabs when these cannot be obtained. The importance of appropriate radiology including plain radiography and MR scanning for diagnosis of osteomyelitis is also highlighted. Prompt initiation of antibiotic therapy is mandatory in the management of diabetic foot infection and the choice of antibiotics should be based on structured hospital protocols, personal preferences and the particular clinical situation. The response to antibiotics should be based on both clinical response and results of microbiology specimens. Duration of antibiotic therapy should be based on severity of infection and type of bacterial growth, with prolonged antibiotic therapy usually necessary for patients with established osteomyelitis. The importance of Charcot arthropathy is also highlighted in a separate section emphasising the need for urgent referral to the multidisciplinary foot care team. Plain radiography, followed by MR scan if plain X-ray is normal, is crucial in the early diagnosis of Charcot foot. Early offloading and close monitoring by means of foot skin temperatures and serial X-rays are an important part of clinical management and bisphosphonates should not be used to treat Charcot arthropathy unless part of a clinical trial. In a separate section, the new NICE guidelines also make some research recommendations for treatments such as negative pressure wound therapy, maggot debridement, and a proposition for more randomised control trials looking at the clinical effectiveness of different ulcer dressings.

Short communication: Determination of the ability of Thymox to kill or inhibit various species of microorganisms associated with infectious causes of bovine lameness in vitro

Infectious claw diseases continue to plague cattle in intensively managed husbandry systems. Poor foot hygiene and constant moist environments lead to the infection and spread of diseases such as digital dermatitis (hairy heel warts), interdigital dermatitis, and interdigital phlegmon (foot rot). Currently, copper sulfate and formalin are the most widely used disinfecting agents in bovine footbaths; however, the industry could benefit from more environmentally and worker friendly substitutes. This study determined the in vitro minimum inhibitory concentrations and minimum bactericidal concentrations of Thymox (Laboratoire M2, Sherbrooke, Québec, Canada) for a selection of microorganisms related to infectious bovine foot diseases. Thymox is a broad-spectrum agricultural disinfectant that is nontoxic, noncorrosive, and readily biodegradable. The values for minimum inhibitory concentration and minimum bactericidal concentration indicated that Thymox inhibited growth and killed the various species of microorganisms under study at much lower concentrations compared with the recommended working concentration of a 1% solution. Overall, the values found in this study of minimum inhibitory concentration and minimum bactericidal concentration of Thymox show its potential as an alternative antibacterial agent used in bovine footbaths; however, field trials are needed to determine its effectiveness for the control and prevention of infectious claw diseases.

Chaim Potok: Confronting Modernity through the Lens of Tradition

Chaim Potok: Confronting Modernity through the Lens of Tradition