Risk Of Foot Problems Research Articles

Unraveling the Role of Tumor Necrosis Factor-Alpha in Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis.

Diabetic peripheral neuropathy (DPN) is a prevalent and debilitating complication of diabetes mellitus, leading to sensory abnormalities, decreased balance, and increased risk of foot problems. Although tumor necrosis factor-alpha (TNF-α) has emerged as a potential factor in the pathogenesis of DPN, its role remains contested. This study intends to thoroughly analyze the association between TNF-α and DPN by combining data from various global studies. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included 23 articles investigating TNF-α levels in DPN patients for systematic review and 11 articles for meta-analysis. Data were extracted, and heterogeneity was examined. A random-effect model was chosen due to high heterogeneity. The major outcome measure across studies was serum TNF-α levels. The meta-analysis found a significant mean difference of 15.2464 (95% confidence interval = 4.4963; 25.9965) under the random-effect model due to the substantial heterogeneity (I2 = 98.1%) among included studies. The meta-analysis indicates a consistent elevation in TNF-α levels in individuals with DPN compared to those without neuropathy. This underlines the potential of TNF-α as a biomarker and contributor to diabetic neuropathy. Despite heterogeneity, the study's extensive scope and systematic approach enhance the trustworthiness and generalizability of the findings.

Two Arm Single-blind Parallel Randomized Controlled Trial Effects of Health Education Intervention on Foot Self-care Behavior Among Diabetic Patients: Study Protocol

Introduction: Diabetes is a chronic illness and it has a significant impact on health. Behavioral interventions theory could improve self-care practices of the foot among patients with diabetic. Behavioral interventions could prevent the risk of foot problems. This trial aims at determining the effect of patient education intervention on foot self-care behavior and clinical outcomes among diabetes patients. Methods: The study is a two-arm single-blinded randomized controlled trial which will be conducted in the Federal Medical Centre (FMC) Owerri, Imo state, Nigeria involving 160 diabetic patients. A central computer-generated randomization list will be generated. Sequentially numbered sealed opaque envelopes will be used to determine concealment. The sample size is 160; therefore 80 participants will receive three sessions of patient education in addition to usual care (intervention group) for three and six months while another 80 participants (control group) will receive only usual care and will receive health education after the study is completed. The outcome of the intervention effectiveness is measured by modified version of Diabetes foot Self-Care Behavior Scale (DFSBS). Discussion: Our hypothesis is that based on the Health Belief Model, patient education intervention can improve foot self-care behavior in the intervention group. Data collection will be done at baseline, and at three- and six-months post intervention. Trial Registration: The Clinical Trials Registry- India (CTRI), Reference no CTRI/2021/06/034311.

Diabetic Foot Risk Assessment among Patients with Type 2 Diabetes in Kenya.

Screening for diabetic foot complications is often neglected, especially during routine and/or annual diabetes check-ups. We assessed the risk of diabetic foot complications among patients with type 2 diabetes in Kenya using the International Working Group on Diabetic Foot risk stratification guidelines to highlight the need for improved foot care. We conducted a descriptive cross-sectional study in Mathari National Teaching and Referral Hospital in Kenya between July and October 2015. Seven hundred patients with type 2 diabetes were identified and 147 were systematically sampled. A trained podiatrist examined patients, and urine and blood samples were taken for biochemical tests and assessed by the investigating team. In total, 44(29.9%) men and 103(70.1%) women were sampled; 75(51.0%) were aged over 55 years, 113(76.9%) were overweight/obese, 117(79.6%) had poor glycaemic control and 125(85%) had never had their feet screened for complications. Thirty participants (20.4%) were categorised as being at high risk for developing diabetic foot complications while 54(36.7%) had moderate risk, 53(36.1%) had low risk and 10(6.8%) had no risk. Compared to other risk groups, those with moderate risk for developing diabetic foot problems had higher mean levels of glycated haemoglobin (9.4%), albumin-creatinine ratio (50.3) and high-density lipoprotein cholesterol (1.4 mmol/L) at presentation. No other differences in clinical and laboratory profiles were noted. Our results show high rates of obesity, and poor glycaemic control in patients with type 2 diabetes and 56.5% of patients are categorised as being a moderate-to-high risk for foot problems. This highlights the need for healthcare professionals and patients in Kenya to be sensitised regarding the importance of foot screening to prevent lower-extremity complications.

Development of a foot care model to determine the risk of foot problems among homeless adults in Canada.

Foot care is a common problem for homeless adults in cities, who often receive fragmented foot care services, resulting in increased foot problems, health complications, hospitalisation, limb removal and disabilities. Among the health factors that negatively affect the homeless, foot health is essential, but often neglected. This study employed a descriptive, cross-sectional research design to assess the foot care of homeless people and develop recommendations for clinical practice. Using Inlow's 60-s foot screening method, the foot conditions of a purposive sample of 65 homeless adults were examined in British Columbia, Canada, in 2019-2020. Descriptive and inferential statistics were used to analyse the data. Determinants, such as sex and years of homelessness significantly contributed to homeless individuals' risk of developing foot problems. Differences in perceived and observed foot problems were influenced by equitable access to social health and healthcare services. Foot assessment is not well-covered by homeless health services and should be implemented as part of the standard medical review of homeless patients. Furthermore, foot assessment should be conducted by healthcare professionals, rather than relying on the standard practice of service users' self-report. Finally, foot care should be based on tailoring assessments and interventions for the individualised needs of homeless service users. Future research must seek ways to integrate homeless individuals' voices in the development, implementation and evaluation of foot care services.

Diabetes and foot problems: The role of the practice nurse

As the number of people being diagnosed with diabetes continues to increase, practice nurses need to understand the associated conditions. Linda Nazarko explains diabetic foot care, the development of ulcers, and methods to support people with diabetes Around 1.4 million people in the UK had diabetes mellitus (DM) in 1996 ( Diabetes UK, 2010 ). There are now 3.59 million people who have been diagnosed ( Diabetes UK, 2017 ). In the past, diabetic foot care was managed by podiatrists; however, in recent years practice nurses have begun to undertake diabetic foot assessments ( Lakha and Lee, 2018 ). DM increases the risk of foot problems and the person with diabetes is vulnerable to major complications, including ulcers and amputations. A person with DM is 30 times more likely to require an amputation than a person without diabetes ( Khanolkar et al, 2008 ). Every day, 20 people with diabetes have a lower limb amputation in England ( Diabetes UK, 2016 ). Routine foot care assessments and risk ratings can enable the nurse to determine the patient's level of risk and know when to refer; they can also determine the frequency of monitoring. The practice nurse can also educate and support the person with diabetes to manage their health to reduce the risks of foot problems. Simple interventions such as smoking cessation, inspecting feet daily, seeking help if there are any concerns, and wearing suitable footwear can reduce the risk of ulcers and amputations and improve quality of life. This article aims to enable the practice nurse to understand the components of diabetic foot care, the reasons why people with diabetes develop foot ulcers, and to enable the practice nurse to provide appropriate care and support to people with diabetes.

Diabetes series, 6. Prevention and management of diabetic foot problems

Diabetes mellitus (DM) increases the risk of foot problems and the person with diabetes is at risk of major complications, including ulcers and amputations. A person with DM is 30 times more likely to require an amputation than a person without diabetes ( Khanolkar et al, 2008 ). Every day, 20 people with diabetes have a lower limb amputation ( Public Health England, 2016 ). Simple interventions such as smoking cessation, inspecting feet daily, seeking help if there are any concerns and wearing suitable footwear can reduce the risk of ulcers and amputations and improve quality of life. This article aims to educate the healthcare assistant on the reasons why people with diabetes develop foot ulcers and to enable the healthcare assistant to provide appropriate care and support to people with diabetes.

Foot Conditions among Homeless Persons: A Systematic Review.

IntroductionFoot problems are common among homeless persons, but are often overlooked. The objectives of this systematic review are to summarize what is known about foot conditions and associated interventions among homeless persons.MethodsA literature search was conducted on MEDLINE (1966–2016), EMBASE (1947–2016), and CINAHL (1982–2016) and complemented by manual searches of reference lists. Articles that described foot conditions in homeless persons or associated interventions were included. Data were independently extracted on: general study characteristics; participants; foot assessment methods; foot conditions and associated interventions; study findings; quality score assessed using the Downs and Black checklist.ResultsOf 333 articles screened, 17 articles met criteria and were included in the study. Prevalence of any foot problem ranged from 9% to 65% across study populations. Common foot-related concerns were corns and calluses, nail pathologies, and infections. Foot pathologies related to chronic diseases such as diabetes were identified. Compared to housed individuals across studies, homeless individuals were more likely to have foot problems including tinea pedis, foot pain, functional limitations with walking, and improperly-fitting shoes.DiscussionFoot conditions were highly prevalent among homeless individuals with up to two thirds reporting a foot health concern, approximately one quarter of individuals visiting a health professional, and one fifth of individuals requiring further follow-up due to the severity of their condition. Homeless individuals often had inadequate foot hygiene practices and improperly-fitting shoes. These findings have service provision and public health implications, highlighting the need for evidence-based interventions to improve foot health in this population. An effective interventional approach could include optimization of foot hygiene and footwear, provision of comprehensive medical treatment, and addressing social factors that lead to increased risk of foot problems. Targeted efforts to screen for and treat foot problems could result in improved health and social outcomes for homeless individuals.

An optimized design of in-shoe heel lifts reduces plantar pressure of healthy males

Conventional heel lift with a flat surface increases the risk of foot problems related to higher plantar pressure and decreased stability. In this study, an optimized design of in-shoe heel lifts developed to maintain the midfoot function was tested to investigate if the plantar pressure distribution was improved. The design was based on three dimensional foot plantar contour which was captured by an Infoot 3D scanning system while the heel was elevated by a heel wedge. To facilitate midfoot function, an arch support was designed to support the lateral longitudinal arch, while allowing functional movement of the medial longitudinal arch. Twenty healthy male subjects were asked to walk along an 8m walkway while wearing high-cut footwear with and without the optimized heel lift. Peak pressure, contact area and force–time integral were measured using the Pedar insole system. Range and velocity of medial-lateral center of pressure during forefoot contact phase and foot flat phase were collected using a Footscan pressure plate. Compared to the shoe only condition, peak pressure under the rearfoot decreased with the optimized heel lift, while no increase of peak pressure was observed under the forefoot and midfoot regions, indicating improved plantar pressure distribution. The findings of this study suggest that this optimized heel lift has better biomechanical performance than a conventional flat heel lift. Results from this study may have implications for insole and shoe last design, especially for people who need additional heel height without sacrificing midfoot function.

Barriers to preventive and curative foot care behaviors in person with diabetes. Suggestions for therapeutic patient education

Aim: The purpose of this study is to explore barriers most likely to interfere with person with diabetes’ preventive and curative behaviors with regard to their feet and to offer suggestions for patient education based on this analysis. Methods: Thirty persons with Type 2 diabetes mellitus at high risk for foot problems were interviewed. A concept map was constructed and supplemented by questions exploring disease representations, locus of control, perceived severity, perceived competence, and patient education needs. A comparative analysis was performed between two groups: seventeen patients with recurrence of foot ulcers, and 13 patients with no recurrence. Results: Patients with recurrence were more likely than those without recurrence to emphasize the negative impact of the ulcer on their daily live, their locus of control was more external than that of patients without recurrence. Patients with no recurrence demonstrated a “preventive attitude” characterized by the fact that they were more likely to emphasize preventive care on their concept maps than were patients with recurrence. They also expressed greater perceived competence in avoiding and detecting the first signs of foot ulcers than did patients with recurrence. Conclusion: Based on the observed differences between patients with and without recurrences, we propose some improvements in patient education programs, focusing more on increasing patients’ understanding of the mechanisms of foot ulcers, helping them develop a preventive attitude, and increasing their perceived competence in avoiding ulcers.

Developing an educational resource about preventing foot problems for people with diabetes: Part 2 – Creating and testing the resource and assessing its initial impact

One of the major complications of diabetes is the development of nerve damage and poor circulation, both of which can lead to foot problems such as ulceration and serious long-term infection. These complications have heavy personal, social, and economic costs associated with them. However, it is possible to either delay or prevent the development of foot ulcers by managing diabetes successfully and following a regular footcare routine. For this preventative strategy to be successful it needs to be implemented at diagnosis, while the individual is at low risk of developing foot problems. To manage their footcare and therefore reduce the risk of diabetic complications, people need access to reliable, high-quality information. Researchers acknowledge that an individual's understanding of footcare, and their behaviour, can be positively influenced by information, though there has been little research to date examining this strategy in people who are at low risk of foot problems. This is the second of two articles describing the development of a resource aimed at people with diabetes, to help them prevent foot problems. The first article detailed the research and audit process and a series of focus groups with people with diabetes. This second article describes how the information resource was planned, written, and evaluated. It includes work to gain a consensus from health professionals about good footcare and preventative behaviour and user insight on the content, tone, style, and design and layout of the resource. The article concludes with some early evaluation of the project.

Factors influencing the awareness of diabetic foot risks

Introduction The aim of the present study was to identify factors influencing diabetic patients’ awareness of the risk of foot problems. Methods We performed a prospective study of diabetic patients hospitalized or seen in consultation. Various factors were analyzed in order to identify those related to the patients’ level of awareness of risk factors in diabetic foot. Results Ninety-one patients were included (mean age: 48; male/female gender ratio: 0.63). Over 50% of the study population was not aware of the risks of diabetic foot. Educational level and socioeconomic status had an impact on awareness of good foot health and care. Poor knowledge of the degenerative complications of diabetes was associated with age, a low educational level and low socioeconomic status. Discussion Our results revealed low levels of patient awareness concerning the potential severity of diabetic foot and the means of preventing foot problems. The patients gave a range of explanations for this marked lack of awareness; including a lack of information and financial constraints. Hence, patient education is still a major aspect of prevention in diabetes. Conclusion In diabetes, there is still a need for easily assimilated, locally provided patient education.

Developing a resource for people with diabetes about preventing foot problems: research, audit and user insight

One of the major complications of diabetes is the development of nerve damage and poor circulation, both of which can lead to foot problems such as ulceration and serious long-term infection. These complications have heavy personal, social and economic costs associated with them. However, it is possible to either delay or prevent the development of foot ulcers by managing diabetes successfully and following a regular footcare routine. For this preventative strategy to be successful, it needs to be implemented at diagnosis, while the individual is at low risk of developing foot problems. To manage their footcare, and therefore reduce the risk of diabetic complications, people need access to reliable, high quality information. Researchers acknowledge that an individual's understanding of footcare, and their behaviour, can be positively influenced by information, although there has been little research to date examining this strategy in people who are at low risk of foot problems. This paper describes the first stages of the development of a resource aimed at people with diabetes to help them prevent foot problems. This first stage includes an audit of evidence and health information materials and a series of focus groups with people with the condition.

Diabetic foot care in a long-term facility.

Foot problems continue to be a major cause of morbidity, disability, and mortality for individuals with diabetes. According to Rothman's model of causation, as interpreted by Pecoraro, Reiber, and Burges (1990), each amputation related to diabetes implies the existence of a completed causal pathway of predisposing factors. The purpose of this descriptive retrospective study was to evaluate foot care provided to residents in a 179-bed long-term care facility. The charts of all 17 eligible residents with a diagnosis of diabetes mellitus were reviewed for documentation of assessment and care of their feet. All data were collected by the investigator using the Minimum Data Set (MDS) 2.0 Assessment of Diabetic Foot Care Instrument and a demographic and foot care history instrument. Foot problems were documented for 59% of the participants. Podiatrist-documented foot examination was found in only one of the charts reviewed; however, six residents had been referred to podiatrist. Throughout the charts reviewed, no documentation of protective sensation using the Semmes-Weinstein monofilament or vibration test was found. The findings of this study are consistent with previous research that showed a gap exists between the established standard and the degree to which the standards are met (Fain & Melkus, 1994; Wylie-Rosett et al., 1995). Adequate attention to the problem by health care providers, efforts to increase awareness of foot care standards, and early intervention may be steps to close the gap. Nurses must identify patients at risk for foot problems and actively intervene to prevent complications from occurring.

FOOTSTEP: a randomized controlled trial investigating the clinical and cost effectiveness of a patient self-management program for basic foot care in the elderly

Background and Objectives Podiatry (chiropody) services are one of the most frequently requested services in primary care. The elderly are given priority access to podiatry services in the UK blocking access for other priority groups. To evaluate the clinical and cost-effectiveness of a self-management program as a means of managing nonurgent demands for podiatry services by the elderly without compromising foot-related disability. Method Randomized clinical trial with blinded 6-month follow-up and economic evaluation. People aged 60+ seeking self-initiated or primary referred podiatric consultation were screened. Five hundred ninety-nine were excluded on the basis of health status, and 259 refused to participate or did not attend initially. Seventy-eight were randomized to receive a self-management program, and 75 usual care. The main outcome measure was foot disability, as measured by the Manchester Foot Disability Questionnaire. Results At 6 months, self-management program participants had lower foot disability scores than the usual care group (difference between scores −1, 95% C.I. −2, 0), and returned for fewer treatments within the 6-month study period (39 vs. 92 treatments). The cost per patient for the self-management program (£10.92) was found to be the same as for usual care (£10.71), but this included the cost of nail care packs. Conclusion In this group a self-care program for routine foot care did not compromise therapeutic outcomes, and may be more cost effective in the long term. Further work is required to extend self-management programs to other target groups, such as people with diabetes at low risk for foot problems.

Assessing and preventing foot problems in older patients who have diabetes mellitus

The first component of prevention is patient education. The patient and those who provide care for the older diabetic must be fully informed of their problems, but understand the management process and be willing to make the lifestyle changes necessary to prevent complications. Evaluating patients to determine those diabetics who are at risk for foot problems, complication, ulceration, or potential amputation is the second component of prevention. This process must include continuing surveillance and management. Recognizing symptoms and signs of various systems with primary evaluative procedures permits the early identification of complications and secondary prevention of chronic disease. Because Medicare now provides footwear and orthotic coverage for at-risk diabetics as an adjunct to management, early screening, assessment, and detection are essential. The provision of significant patient education can then be added to complement professional education. We have attempted to provide a process for proper referral for care and management that can be employed by all health care providers involved in the evaluation of the patient who has diabetes.

The Prevalence and Nature of Podiatric Problems in Elderly Diabetic Patients

To determine if diabetes in the elderly is associated with increased prevalence of podiatric problems, a random sample of diabetic patients (n = 74) was compared to a group of elderly non-diabetic patients (n = 79). The two groups were comparable in age (range 70-90 years), smoking habits, and consumption of alcohol. The mean duration of diabetes was 14.5 +/- 11.7 years (+/- SD), and mean serum fructosamine level was 3.3 +/- 0.66 mmol/L. The number of medical diagnoses and medications used was significantly higher in the diabetic group. Diabetic patients had modestly higher prevalence of neuropathy, vascular disease, kidney disease, and eye complications. The most common podiatric problem in both groups was elongated toenails. The prevalence of podiatric problems such as cellulitis, amputation, tinea pedia, onychomycosis, calluses, bunions, and hammer toe deformity were not increased in diabetic patients. Active foot ulcers were more common in diabetic patients (13/74 vs 5/79, P less than 0.05). It is concluded that diabetes in the elderly, unlike in young patients, increases the risk of foot problems only marginally.