Prevalence Of Foot Research Articles

Description clinique et radiologique des malformations des pieds et des membres inférieurs chez les patients atteints du syndrome de Down

Subjects with Down syndrome (DS) are known to be affected by various lower limb deformities [1], [2]. Foot deformities are often neglected in DS patients because of the high prevalence of concomitant life threatening disorders. The aim of this study is to investigate the prevalence of clinical and radiological feet and lower limb deformities in patients with DS. Fifty-five subjects with DS (14.6 A7.4 years) had undergone podiatric clinical and podoscopic examinations to study their main foot deformities and their footprints, respectively. The results of these examinations were compared to those of an age-matched asymptomatic control group of 53 subjects (13.4 A11.2 years). Forty-two subjects of the DS group (15 A7 years) had undergone an EOSy biplanar X-rays exam of their pelvis and lower limbs. The EOS parameters were compared to an asymptomatic control group of 27 subjects (16.12 A6 years). The following foot deformities were found to be significantly more prevalent in DS group - hallux valgus (36.4%), syndactyly between 2nd–3rd toes (9.1%), grade II pes planus (39.1%) and grade III pes planus (30%). Moreover, an increased space between the 1st and 2nd toes in patients with DS with a prevalence of 73.6% was found. Patellar instability (42.7%) and joint laxity (43.6%) were also significantly more prevalent in the DS group. The following EOS parameters were significantly higher in DS group compared to control group - pelvic incidence (53°A13° vs. 44°A10°, P < 0.001), sacral slope (48°A9° vs. 37°A6°, P < 0.001) and femoral neck-shaft angle (133°A6° vs. 131°A5°, P = 0.021). On the other hand, other EOS parameters were significantly higher in the control group - femoral head diameter (mean = 41 vs. 38) and femoral offset (mean = 37.64 vs. 34). There were no significant differences between the DS and the control groups for both femoral anteversion and tibial torsion. This study confirms the previously reported high prevalence of foot deformities in patients with DS [2]. Furthermore, increased space between the first and second toes was described for the first time in Down syndrome patients. Considering its high prevalence, further studies should be directed towards exploring the functional implications of this deformity. To our knowledge, this is the first study to measure lower limb and pelvic radiological parameters of patients with DS. The morphology of both the pelvis and the proximal femur were affected in patients with DS. Further studies should explore the effect of these anomalies on gait and posture in this group of patients.

Habitual physical activity, peripheral neuropathy, foot deformities and lower limb function: characterising prevalence and interlinks in patients with type 2 diabetes mellitus

Background: Patients with type 2 diabetes mellitus (T2DM) may have diverse foot problems, but how these problems are linked with physical activity is not clear. This study investigated the prevalence of foot problems among patients with T2DM and investigated how the problems were related to physical activity.Methods: Habitual physical activity, peripheral neuropathy, lower limb functions and foot deformities of 246 T2DM patients were respectively assessed with the Baecke Physical Activity Questionnaire, Michigan Neuropathy Screening Instrument, Lower Limb Function Scale, and a self-designed foot deformity audit form.Results: Habitual physical activity index (3.2 ± 0.83) was highest in work-related activities; 69 (26.1 %) patients presented with peripheral neuropathy and 52 (19. 7%) had the lowest limb function. Pes planus was the most prevalent foot deformity (20.1%). Significant differences existed in physical activity indices across deformity groups (p < 0.05) and total activity index was related to neu...

Temporal changes in the prevalence and associates of foot ulceration in type 2 diabetes: The Fremantle Diabetes Study

AimsTo assess temporal changes in foot ulceration and its risk factors in community-based people with type 2 diabetes. MethodsBaseline data from the longitudinal observational Fremantle Diabetes Study collected from 1993 to 1996 (Phase I) and 2008 to 2011 (Phase II) were analyzed. Generalized linear modeling was used to examine changes in foot ulcer prevalence and its associates between phases. Multiple logistic regression was used to determine associates of prevalent foot ulceration in individual and pooled phases. ResultsThere were 16 foot ulcers among 1296 patients in Phase I (1.2%) and 23 in 1509 Phase II patients (1.5%; P=0.86 after age, sex and race/ethnicity adjustment). Glycemic and non-glycemic cardiovascular risk factors were better in Phase II, but diabetes duration was longer, peripheral sensory neuropathy (PSN) was more prevalent and more patients were Aboriginal (P<0.001) than in Phase I. In multivariable analysis of both phases and pooled data, diabetes duration and peripheral sensory neuropathy (PSN) were independent associates of foot ulceration (P≤0.026). Prior hospitalization for ulcer, intermittent claudication, any absent pedal pulse and Aboriginality were also significant in the pooled model (P≤0.009). ConclusionsStrong associations between foot ulcer and diabetes duration, PSN, symptomatic and clinically-detectable peripheral vascular disease were observed. Aboriginality also proved an independent risk factor. Since all these risk factors apart from intermittent claudication and impalpable foot pulses were more prevalent in Phase II, improved community- and hospital-based foot care between phases are likely to have attenuated the risk of foot ulcers in Phase II patients.

Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: study protocol for a prospective observational cohort study.

BackgroundAdults with end-stage renal disease treated with dialysis experience a high burden of foot ulceration and lower extremity amputation. However, the risk factors for foot ulceration in the dialysis population are incompletely understood due to the lack of high-quality prospective evidence. This article outlines the design of a prospective observational cohort study, which aims to investigate the risk factors for foot ulceration in adults on dialysis.Methods/DesignThis study will recruit 430 participants with end-stage renal disease on dialysis from satellite and home-therapy dialysis units across multiple health organisations in Melbourne, Victoria, Australia. Data collection at baseline will include a participant interview, medical record review, completion of a health-status questionnaire and a non-invasive foot assessment. Twenty participants will also be recruited to a reliability study to evaluate the reproducibility of testing procedures. Primary outcome data includes: new foot ulcer(s). Secondary outcome data includes: number of new foot ulcers, time to onset of new foot ulcer(s), new lower extremity amputation(s), episodes of infection of the foot or lower extremity, episodes of osteomyelitis, foot-related hospitalisations, revascularisation procedure(s) of the lower extremity, new podiatry interventions, kidney transplantation, and mortality. Participants will be assessed at baseline, and at 12 months they will be evaluated for the primary and secondary outcomes. Multivariate Cox proportional hazards models will be used to assess predictors of new foot ulceration and time to event secondary outcomes. Logistic regression will be used for binary outcomes including prevalence of foot ulcerations.DiscussionThis is the first multi-centre prospective observational cohort study to investigate risk factors for foot ulceration in adults with end-stage renal disease on dialysis. This study will improve on prior studies by using prospective methods, multi-centre recruitment, statistical methods to control for confounding variables, and a pre-specified sample size estimation. The findings can inform the design of future trials evaluating the effectiveness of clinical interventions, which may lead to improved patient outcomes in the dialysis setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0110-9) contains supplementary material, which is available to authorized users.

Foot and ankle deformity in young acrobatic and artistic gymnasts

PurposeThe aim of the paper was to determine the occurrence of feet and ankle deformities in trampoline and artistic gymnasts.MethodsTen acrobatic gymnasts (trampolinists) and 10 artistic gymnasts aged 6-14 years were recruited. The calcaneal-tibial (rearfoot) angle was determined as the angle of the upper calcaneal tendon and the longitudinal heel axis while Clarke angles were determined by podoscopy.ResultsThe trampolinists showed significantly greater medial angulation (calcaneal valgus) than the group of gymnasts. Right and left foot Clark’s angles in both the trampoline and artistic gymnasts were above 55°.ConclusionsTrampolinists exhibit significantly more pronounced calcaneal valgus than artistic gymnasts. The prevalence of foot and ankle deformities in both populations should be addressed by coaches in the gymnastics training of young children.

A podiatry survey: how do we treat hallux valgus conservatively?

Background Hallux valgus (HV) is a prevalent foot deformity with limited research available to guide decisions regarding conservative management. Clinical guidelines are largely based on expert opinion with little evidence of what actually occurs in day-to-day practice. An increased understanding of non-surgical treatment options currently utilised by podiatrists is needed to potentially improve clinical practice, education and research. The aim of this survey was to explore current practice among Australian podiatrists treating HV in light of current clinical guidelines.

An aggressive and multi-pronged approach to prevent amputations in India

Foot complications are a major cause of hospitalization in diabetes. Diabetic foot ulceration results from decreased blood supply, poor weight-bearing, loss of sensation and poor foot care. Foot complications both increase the health care costs and pose a heavy socioeconomic burden. A study from India reported that the cost of diabetes care for a patient with foot ulcers was more than 4 times higher (INR 19 020; US$409) than that for a patient without foot ulcers (INR 4493; US$97) [1]. In India, most of the patients undergo major or minor amputations due to the failure of antimicrobial therapy against infections. The causes of amputations may vary based on geographical variations. An earlier hospitalbased multi-centric study to determine the prevalence of diabetic foot in India reported that the prevalence of foot infection among diabetic patients was 6–11 % and that of amputation was 3 % [2]. Another multicentric study involving 31 study sites across India reported that major amputations comprised about 29.1 % and minor amputations 70.9 % among diabetic patients with foot infection, and 82 % of them had neuropathy and 35 % had peripheral vascular disease. This study also observed that infection was a significant cause of amputation in approximately 90 % of the study population [3]. The study of Durgad et al. [4 ]e mphasizes the microbial etiology of diabetic foot ulcers and their susceptibility patterns. They studied 70 diabetics and isolated 147 organisms from wound swabs and pus aspirates. About 42 % of the diabetic patients were in poor glycemic control and more than 50 % of patients studied had more serious form of infection as indicated by Wagner’ sg rade 3–5 lesions. Out of 70 diabetics, 73 % of patients were infected by the polymicrobial infection and the microbiological analysis revealed the high proportion of gram negative bacilli (57 %) compared to gram positive cocci (27 %). Among gram positive cocci, 23 % of Staphylococcus aureus isolates and 17 % of coagulase negative Staphylococcal isolates were found to be methicillin resistant. As to gram negative bacilli, 23 % of isolate belonged to the Enterobacteriaceae family and were extended spectrum beta lactamase producers. The high prevalence of multidrug-resistant organisms (MDROs) in the clinical settings, increase the extent of hospitalization and cost of management. These data report the prevailing existence of MDROs in the tertiary clinical settings and the diabetic patient’s vul

MOLECULAR AND SEROLOGICAL IDENTIFICATION OF FOOT-AND-MOUTH DISEASE VIRUS SEROTYPES IN CATTLE OF BASRAH PROVINCE

This study was conducted on serum from 6 different regions covering all parts of the Basrah province during the period from October 2012 to June 2013 in order to determine the prevalence of foot and mouth disease in bovine species. From the serology results, the overall prevalence of this disease was(72.7%.) . Of the 165 samples subjected to Nonstructural protein (NSP) enzyme linked immunosorbent assay (ELISA) screening test, 120 were interpreted as positive representing (72.7%.) while the other 45 samples were negative representing 27.3%. The seropositivity significantly associated with age groups (p 0.05) while the difference among age groups was significant (P < 0.05)

Prevalence and risk factors for foot and ankle musculoskeletal disorders experienced by nurses.

BackgroundNurses are at high risk of musculoskeletal disorders (MSDs). Although the prevalence of MSDs of the lower back, upper limbs, neck and shoulders have been reported previously in nursing, few studies have evaluated MSDs of the foot and ankle. This study evaluated the prevalence of foot and ankle MSDs in nurses and their relation to individual and workplace risk factors.MethodsA self-administered survey incorporating the Nordic Musculoskeletal Questionnaire (NMQ) was distributed, over a nine-week period, to all eligible nurses (n = 416) working in a paediatric hospital in Brisbane, Australia. The prevalence of MSDs for each of the NMQ body regions was determined. Bivariate and multivariable logistic regression analyses were conducted to examine the relationships between activity-limiting foot/ankle MSDs and risk factors related to the individual (age, body mass index, number of existing foot conditions, smoking history, general physical health [SF36 Physical Component Scale], footwear features) or the workplace (level of nursing position, work location, average hours worked, hours worked in previous week, time since last break from work).ResultsA 73% response rate was achieved with 304 nurses completing surveys, of whom 276 were females (91%). Mean age of the nurses was 37 years (±10), younger than the state average of 43 years. Foot/ankle MSDs were the most prevalent conditions experienced by nurses during the preceding seven days (43.8%, 95% CI 38.2-49.4%), the second most prevalent MSDs to impair physical activity (16.7%, 95% CI 13.0-21.3%), and the third most prevalent MSD, after lower-back and neck problems, during the preceding 12 months (55.3%, 95% CI 49.6-60.7%). Of the nurse and work characteristics investigated, obesity, poor general physical health, existing foot conditions and working in the intensive care unit emerged as statistically significant (p < 0.05) independent risk factors for activity-limiting foot/ankle MSDs.ConclusionsFoot/ankle MSDs are common in paediatric hospital nurses and resulted in physical activity limitations in one out of every six nurses. We recommend targeted education programs regarding the prevention, self-management and treatment strategies for foot/ankle MSDs. Further research is needed into the impact of work location and extended shift durations on foot/ankle MSDs.

Self-care into the risk factors in diabetic foot ulceration: cross-sectional study

Aim: To analyze the implications of self-care on the risk factors of ulceration in the feet of patients with diabetes mellitus, related to dermatology, orthopedic, neurological and vascular alterations. Method: Cross-sectional study, involving 1,515 patients with diabetes mellitus type 2, older than 40 years, enrolled in basic health units. Results: The prevalence of feet at risk of ulceration was 12.3%. Changes in tibial and dorsalis pedis pulses, the altered capillary filling, the presence of bony prominences, hallux valgus, claw and hammer toes and the loss of protective sensation in the feet were associated with the risk of ulceration. Discussion: The prevalence of feet at risk of ulceration was considered high and is related to different dermatological, vascular and neuropathic factors permeated by the self-care factor. Conclusions: The prevention of alterations in the diabetic foot involves maintenance of glycemic control and specific foot care.

Prevalence and risk factors for diabetes-related foot complications in Translating Research Into Action for Diabetes (TRIAD)

AimsThe objective was to describe the prevalence of diabetes-related foot complications in a managed care population and to identify the demographic and biological risk factors. MethodsWe assessed the period prevalence of foot complications on 6992 patients using ICD-9 diagnosis codes from health plan administrative data. Demographic and biological variables were ascertained from surveys and medical record reviews. We defined four mutually exclusive groups: any Charcot foot, DFU with debridement, amputation±DFU and debridement, and no foot conditions. ResultsOverall, 55 (0.8%) patients had Charcot foot, 205 (2.9%) had DFU with debridement, and 101 (1.4%) had a lower-extremity amputation. There were 6631 patients with no prevalent foot conditions. Racial/ethnic minorities were less likely to have Charcot foot (OR=0.21; 95% CI: 0.10, 0.46) or DFU (OR=0.61; 95% CI: 0.44, 0.84) compared to non-Hispanic Whites, but there were no racial/ethnic differences in amputation. Histories of micro- or macrovascular disease were associated with a two- to four-fold increase in the odds of foot complications. ConclusionIn managed care patients with uniform access to health care, we found a relatively high prevalence of foot complications, but attenuation of the racial/ethnic differences of rates reported in the literature.

Use of Beach Shoes for Foot Protection during the Bangkok Flood of 2011

Foot injury was common as a result of the Bangkok flood of 2011. In the future, this type of injury should be prevented to lessen the burden during a disaster. The study was performed to ascertain what type of footwear is appropriate for volunteer rescue workers during a flood. The study was carried out during the flood in November 2011 at Siriraj Hospital. There were 15 volunteers enrolled in the study. None of the volunteers had any foot deformity or injury before the study. Participants were divided into 3 groups of 5 volunteers: group A, the barefoot group; group B, the high top shoe group; and group C, the beach shoe group. All volunteers worked in the areas close to Siriraj Hospital and were followed up after 5 days of rescue work. Prevalence of foot and ankle injuries, satisfaction regarding work conditions and willingness to use the shoes were subjectively evaluated. Wearing of beach shoes during rescue was satisfactory during the early phase of the flood. The age range of volunteers was 20-28. In the group A, most volunteers were barely satisfied with conducting rescue work in water with bare feet, that bare feet were good for working on a wet surface and were 'just satisfied' to not satisfied that bare feet were good for work on dry surfaces. In group B, most of the volunteers had opinions similar to group A with the exception that they felt better while they were working on dry surfaces. In group C, most volunteers were significantly more satisfied under all three conditions. Foot injury occurred in 2 volunteers from group A. Beach shoes offer adequate foot protection during flood rescue.

The population prevalence of foot and ankle pain in middle and old age: A systematic review

A systematic review and meta-analysis of population-based epidemiological studies was undertaken to determine the prevalence of foot and ankle pain in middle and old age. Searches were conducted in the following electronic databases from inception to October 2010: PubMed, EMBASE, AMED, CINAHL, Cochrane, PEDro, and SportDiscus. Full-text English language articles were included if they used population sample frames, cross-sectional design or analysis, and reported prevalence estimates for foot and/or ankle pain in adults aged 45 years and over. Thirty-four articles from 31 studies involving 75,505 participants provided 529 prevalence estimates based on different case definitions and population strata. Random-effects meta-analyses of studies with comparable case definitions provided pooled prevalence estimates, for frequent foot pain of 24% (95% confidence interval 22–25%; n = 3; I 2 = 46%) and for frequent ankle pain of 15% (95% confidence interval 13–16%; n = 2; I 2 = 0). Small sample sizes and low response rates in some studies, together with heterogeneous case definitions, limit confident conclusions on the distribution, subtypes, and impact of foot/ankle pain. Narrative synthesis of evidence from existing studies suggested preponderance in females, an age-related increase in prevalence in women but not men, that the toes/forefoot were the most common anatomical sites of pain, and that moderate disability in an aspect of daily life was reported by two-thirds of cases. This review provides estimates of the community burden of foot and ankle pain in middle and old age. By outlining the scale of this clinical problem, these findings can be used to inform health care planning and provision.

Study on the prevalence of Foot and Mouth Disease in Borana and Guji Zones, Southern Ethiopia

A cross sectional study was conducted on Borana plateau and Guji highlands of southern Ethiopia to determine the prevalence of Foot and Mouth Disease (FMD) in bovine species. Seroprevalence investigation was performed using 3ABC- ELISA technique. The result indicated that the overall prevalence of Foot and Mouth Disease was 24.6 %(113/460). Significantly higher prevalence was recorded in Borana 53.6 % ( 82/153) compared to Guji 10.1 %( 31/307). From the various risk factors, geographical distribution (x²=104.26, P<0.05) and age (x²=6.68, P<0.05) were seen to be significantly associated with the seroprevalence. The result of this study indicated that FMD is highly prevalent in lowland area (Borana) than highland (Guji) due to contact of different origin cattle in search of feed and water. The presence of higher prevalence of Foot and Mouth Disease in pastoralists' cattle of the area warrants further investigation and characterization of the circulating virus serotype to apply effective control and prevention measures.

Prevalence of Foot and Mouth Disease in Cattle and Buffaloes in Central Punjab, Pakistan

An epidemiological investigation conducted in 25 randomly selected villages of the six districts of central Punjab which reported foot and mouth disease. 100 swab samples from buffaloes and cattle were subjected to CFT and then ELISA which determined that FMD serotype “O” was the most prevalent type of antibodies with 67.11%. This was followed by serotype-A with 50.15% and serotype Asia-1 with 39.31%. Statistically significant differences were detected among districts for prevalence of serotypes of FMD. Highest prevalence of FMD serotypes (A, O, Asia-1) were observed in Okara followed by Faisalabad, Multan, Pakpattan, Sahiwal and Khanewal. The high positivity of larger ruminants against FMD serotypes might be due to infectious process or the outbreak wave that comes every year. The effect of the infectious process led to the high production of antibodies in the cattle and buffaloes in the selected districts of Central Punjab. However the role of weekly and monthly livestock markets held every month in Okara and Sahiwal and livestock movements due to sedentary lifestyle of the people and at the eve of Eid ul Azha needs further investigation. Concurrent infections due to all the three serotypes have been confirmed. This suggests to exploring the use of multi-variant vaccine policy for effective control of FMD in the given situation.

Risk factors for foot and ankle disorders among assembly plant workers

Jobs that necessitate prolonged standing and walking activities are commonly associated with worker's complaints of foot and ankle pain. The objective of this study was to determine the relative contributions of work activity (time spent standing, walking, or sitting), floor surface characteristics, weight, BMI, age, foot biomechanics, and other demographic and medical history factors to the prevalence of foot and ankle disorders. A cross-sectional observational study design was used to evaluate employees of an engine manufacturing plant. The main outcome variable was foot or ankle disorders defined by pain and a positive physical examination. The independent variables included baseline demographics, medical history, ergonomic exposures, psychosocial factors, shoe characteristics and foot biomechanics. Twenty-four percent of the cohort met the case definition of foot/ankle disorder with 10% defined as new cases. Fifty-two percent had symptoms of foot/ankle. An increased risk of presenting with foot/ankle disorders was associated with high metatarsal pressure on gait assessment, increased time spent walking, female gender, reported high job dissatisfaction, a history of rheumatoid arthritis, osteoporosis or vascular disorder. For the truck/forklift drivers, an increased number of times getting in and out of the vehicle was associated with a higher prevalence of ankle/foot problems. An increased risk is associated with higher metatarsal pressure and increased time spent walking. These findings suggest several options for primary and secondary prevention strategies. The use of shoe orthoses with a medial longitudinal arch and metatarsal pad as well as including optional sit/stand workstations may be helpful.

Magnetic resonance imaging of the ankle in female ballet dancers en pointe

Ballet dancers require extreme range of motion of the ankle, especially weight-bearing maximum plantar flexion (en pointe). In spite of a high prevalence of foot and ankle injuries in ballet dancers, the anatomy and pathoanatomy of this position have not been sufficiently studied in weight-bearing. Magnetic resonance imaging (MRI) is a beneficial method for such study. To develop an MRI method of evaluating the ankles of female ballet dancers standing en pointe and to assess whether pathological findings from the MR images were associated with ankle pain reported by the subjects. Nine female ballet dancers (age, 21+/-2.9 years; dance experience, 16+/-4.1 years; en pointe dance experience, 7+/-4.9 years) completed an ankle pain visual analog scale questionnaire and underwent T1- and T2-weighted scans using a 0.25 T open MRI device. The ankle was scanned in three positions: supine with full plantar flexion, standing with the ankle in anatomical position, and standing en pointe. Obtaining MR images of the ballet dancers en pointe was successful in spite of limitations imposed by the difficulty of remaining motionless in the en pointe position during scanning. MRI signs of ankle pathology and anatomical variants were observed. Convergence of the posterior edge of the tibial plafond, posterior talus, and superior calcaneus was noted in 100% of cases. Widened anterior joint congruity and synovitis/joint effusion were present in 71% and 67%, respectively. Anterior tibial and/or talar spurs and Stieda's process were each seen in 44%. However, clinical signs did not always correlate with pain reported by the subjects. This study successfully established an ankle imaging technique for ballet dancers en pointe that can be used in the future to assess the relationship between en pointe positioning and ankle pathoanatomy in ballet dancers.

Dialysis Treatment Is an Independent Risk Factor for Foot Ulceration in Patients With Diabetes and Stage 4 or 5 Chronic Kidney Disease

OBJECTIVETo determine whether dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and renal impairment.RESEARCH DESIGN AND METHODSWe performed a cross-sectional study of consecutive patients with diabetes and stage 4 or 5 chronic kidney disease (CKD) attending clinics in Manchester (U.K.). Patients were classified as either receiving dialysis therapy (dialysis) or not (no dialysis). Foot assessment included diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), prior foot ulceration and amputation, and foot self-care. Risk factors for prevalent foot ulceration were assessed by logistic regression.RESULTSWe studied 326 patients with diabetes and CKD (mean age 64 years; 61% male; 78% type 2 diabetes; 11% prevalent foot ulceration). Compared with no dialysis patients, dialysis patients had a higher prevalence of DPN (79 vs. 65%), PAD (64 vs. 43%), prior amputations (15 vs. 6.4%), prior foot ulceration (32 vs. 20%), and prevalent foot ulceration (21 vs. 5%, all P < 0.05). In univariate analyses, foot ulceration was related to wearing bespoke footwear (odds ratio 5.6 [95% CI 2.5–13]) dialysis treatment (5.1 [2.3–11]), prior foot ulceration (4.8 [2.3–9.8], PAD (2.8 [1.3–6.0], and years of diabetes (1.0 [1.0–1.1], all P < 0.01). In multivariate logistic regression, only dialysis treatment (4.2 [1.7–10], P = 0.002) and prior foot ulceration (3.1 [1.3–7.1], P = 0.008) were associated with prevalent foot ulceration.CONCLUSIONSDialysis treatment was independently associated with foot ulceration. Guidelines should highlight dialysis as an important risk factor for foot ulceration requiring intensive foot care.

Pé em risco aumentado de ulceração em doentes com diabetes Mellitus tipo 2

Objectives: To determine the prevalence of foot at increased risk of ulceration in diabetic patients in a Primary Health Care population according to the classification system of the IWGDF. Study Design: Cross-sectional analytical observational. Location: Three Primary Care Centres (PCC) in Matosinhos, Portugal. Population: Patients with type 2 diabetes, holders of the Diabetic Guide and residents in Portugal. Methods:A total of 237 participants were obtained through simple random sampling technique with reposition. The data were obtained through interviews, objective examination and analysis of processes. Demographic data was collected as well as Body Mass Index, diabetes duration and glycaemic control. The presence of peripheral neuropathy and vasculopathy was assessed in order to classify patients according to the classification system of the IWGDF. Results: Among the 237 participants, 46% were male, averaging 63 years. The prevalence of foot at increased risk of ulceration was 18.1% and it was found an association with the condition retirement. Conclusions: This study showed that the prevalence of diabetic patients with foot at increased risk of ulceration in Primary Health Care is significant, highlighting the need for early detection of changes in the foot and investment in the education of diabetics on feet care.

Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study

Foot involvement is a major feature of rheumatoid arthritis (RA). Most epidemiological studies of the RA foot report radiological changes and results of clinical examination. This study aimed to determine the prevalence of foot symptoms, frequency of foot assessment and access to foot care from the perspective of people with RA. A questionnaire was sent to 1,040 people with RA throughout the UK enquiring about foot symptoms, their anatomical distribution (via validated mannequins) availability of podiatry services and perceived usefulness of interventions for alleviating foot symptoms. Altogether 585 useable replies were received; 93.5% of respondents reported having experienced foot pain, and 35.4% reported current foot pain as the presenting symptom. Most (68.2%) reported moderate or severe foot pain daily. Pain was most prevalent in the forefoot and/or ankle. The main predictive factors for reporting current foot pain were longer disease duration (mean 13 vs 10.3 years, p = 0.009), higher BMI (25.6 vs 24.1 p = 0.001) and the prevalent foot symptoms foot stiffness and numbness (both p < 0.0001). Age, gender and current treatment were not significantly associated. Most (82%) had discussed foot symptoms with their rheumatologist, and only 64% had seen a podiatrist. Reported current adherence to prescribed orthoses was 55.8% and to prescribed shoes was 29.5%. Foot symptoms are ubiquitous in RA and frequently severe. Most patients had discussed their symptoms with their rheumatologist, and only 64% had specifically seen a podiatrist. Despite the remarkable progress in development of new treatment modalities for RA, foot pain remains a common and disabling symptom. Our findings support the need for wider access to specific foot care services and evidence-based, patient-centred interventions.