Foot Care (foot + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Economic aspects of diabetic foot care in a multidisciplinary setting: a review

Giovanni A. Matricali
Abstract Background To evaluate the economic aspects of diabetic foot care in a multidisciplinary setting. Method A review of the English language literature, published from 1966 to November 2005. Results The results of available studies on the cost-of-illness of diabetic foot problems are difficult to compare. Nevertheless trends concerning excess of costs, protraction in time of costs, positive correlation to severity of ulcer and/or peripheral vascular disease, contribution of in-hospital stay and length of stay, and the patient's own contribution to total costs, are obvious. Only a few cost-effectiveness and cost-utility studies are available. Most use a Markov based model to predict outcome and show an acceptable result on long-term. Conclusions Diabetic foot problems are frequent and are associated with high costs. A multidisciplinary approach to diabetic foot problems has proved to be cost saving with regard to cost of treatment itself. Nevertheless, it remained unclear if these savings could offset the overall costs involved in implementing this kind of approach. The few studies that address this issue specifically all show an acceptable cost-effectiveness, but often the profit will be evident after some years only, because long-term costs are involved. Based on these data, policymakers should foresee sufficient reimbursement for preventive and early curative measures, and not only for ,salvage manoeuvres'. Copyright 2007 John Wiley & Sons, Ltd. [source]

Foot abnormalities in Canadian Aboriginal adolescents with Type 2 diabetes

J. Chuback
Abstract Aims To determine the profile of foot abnormalities in Canadian Aboriginal adolescents with Type 2 diabetes and the risk factors associated with these abnormalities. Methods Aboriginal adolescents with Type 2 diabetes underwent an interview, medical record review and foot examination in a tertiary care, paediatric hospital diabetes clinic and two geographically remote outreach clinics. The notes of 110 subjects were reviewed [mean age 15 3 years; mean duration of diabetes, 30 20 months; 71 (66%) female and 39 (34%) male] and 77 (70%) of the subjects were examined. Results Foot abnormalities were identified by either interview or notes review, and included poor toenail condition in 85 (77%), paronychia in 29 (26%), ingrowing toenails in 16 (15%) and neuropathic symptoms in 13 (12%) subjects. Foot abnormalities were identified by examination in many subjects, including poor toenail condition in 38 (49%), calluses in 34 (44%) and paronychia in 13 (17%) subjects. Eighteen (24%) of 75 subjects did not have running water in the home. Factors that significantly increased the presence of foot abnormalities included: foot care provided by a person other than self; absence of running water in the home; decreased frequency of bathing; and decreased frequency of nail clipping. A greater percentage of subjects living on a reservation or rural community had specialized consultations for retinal examination, footwear, or both than of those living in an urban or unknown residence. Conclusions A high prevalence of foot abnormalities was noted in Aboriginal adolescents with Type 2 diabetes. These findings highlight the associated comorbidities in this population, emphasizing the need for early detection and intervention. [source]

The epidemiology of diabetic limb sepsis: an African perspective

Z. G. Abbas
Abstract We review the epidemiology of foot and hand sepsis in adult diabetes patients in Africa. Limb sepsis in these patients is associated with significant morbidity and mortality. The pathogenesis of diabetic foot infections in these patient populations appears to be similar to that for patients in industrialized countries ,ulcers and underlying peripheral neuropathy being the most important risk factors. Prevention of peripheral neuropathy through aggressive glycaemic control may be the most important primary control measure for foot infections. The tropical diabetic hand syndrome (TDHS) is being increasingly seen in diabetes patients in certain parts of Africa. The syndrome is acute, usually follows minor trauma to the hand, and is associated with a progressive synergistic form of gangrene. The major risk factors for TDHS are unknown but recent data suggest poor glycaemic control is associated with poor outcome. Treatment of TDHS requires aggressive surgery. Hence, preventive efforts for both foot and hand sepsis include aggressive glucose control, and education on hand and foot care and the importance of seeking medical attention promptly at the earliest onset of symptoms. Diabet. Med. 19, 895,899 (2002) [source]

Educational needs, metabolic control and self-reported quality of life

A study among people with type 2 diabetes treated in primary health care
Abstract The prevalence of type 2 diabetes is increasing. In order to reduce long-term complications and to promote a better life for these patients, health care professionals are important advocates in education and counselling. More knowledge is therefore needed to explore the association between educational needs and quality of life. In total, 211 people with type 2 diabetes (response rate 48%) were recruited from general practices in a geographically well-defined district in Bergen, Norway. All participants completed a questionnaire measuring demographical and clinical variables, quality of life (WHOQOL-Bref), satisfaction with education and counselling, and symptoms related to the disease. A blood sample was taken from each patient for determination of HbA1c. The participants reported receiving most information on diet, physical activity and treatment and less information on foot care and long-term complications. Satisfaction with education was significantly positively correlated with self-reported overall quality of life, and quality of life within domains for psychological health, social relationships and environment. More intensive treatment was significantly associated with lower quality of life within the physical health and social relationships domains. For 32% of the participants, HbA1c values did not satisfy the Norwegian guidelines (adjusted for age). The results from the present study emphasise a need for health education in diabetes primary health care especially in relation to foot care and long-term complications. The association between satisfaction with education and quality of life makes it important to develop educational and counselling methods for nurses in primary health care. Copyright 2005 FEND. [source]

Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?

Susan L. Ettner
Abstract Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3,min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices. Copyright 2008 John Wiley & Sons, Ltd. [source]

Knowledge and practice of foot care in lranian people with type 2 diabetes

Article first published online: 12 DEC 200
No abstract is available for this article. [source]

Patients at risk of onychomycosis , risk factor identification and active prevention

A Tosti
ABSTRACT Objectives, The aims of this workshop were to identify risk factors for onychomycosis and to reach consensus on the management of high-risk groups to allow the development of guidelines to help doctors recognize risk factors that complicate treatment. Results and Conclusions, Previous Trichophyton rubrum infection, older age, abnormal nail morphology, immunodeficiency and genetic factors were identified as risk factors for initial infections. Risk factors for recurrence (relapse and re-infection) are largely the same. The experts agreed that the prevention of onychomycosis and its recurrence should be based on the correct treatment of tinea pedis, screening family members and adequate patient education. In addition, generic management recommendations for each high-risk group were discussed: ,,Immunosuppressed patients ,,Usual dose and treatment length not appropriate ,,Follow-up required ,,Beware of drug interactions ,,Diabetics ,,Prophylactic foot care combined with nail treatment ,,Good opportunity for patient education, footwear, foot care, etc. ,,Beware of drug interactions ,,Psoriatics and patients with abnormal nails ,,Dermatophyte eradication does not restore normal nails ,,Children ,,High failure rate possibly due to compliance problems. [source]

The FOOTSTEP self-management foot care programme: Are rheumatoid arthritis patients physically able to participate?

PgCert, R. Semple BSc Hons
Abstract Background:,The FOOTSTEP self-management foot care programme is a clinical and cost-effective programme for basic foot care in the elderly. The aim of this study was to determine if patients with rheumatoid arthritis (RA) would be physically able to participate. Methods:,A consecutive cohort of RA patients undergoing podiatry care underwent tests for sight, reach and grip strength to determine their physical ability to undertake self-managed foot care. Results:,Thirty RA patients (10 male, 20 female), with a median age of 61 years (range 42 to 84) and disease duration of 10 years (range one to 40), were recruited. All patients passed the sight test, whereas the reach and grip tests were passed by 77% and 67% of patients, respectively. Only 57% of patients passed all the physical tests. Patients who failed the physical tests were older, and had longer disease duration and higher physical disability, pain and general health scores but these were not statistically different. Conclusions:,Just over half the patients in this present cohort may be physically able to undertake some aspects of self-managed foot care, including nail clipping and filing, callus filing and daily hygiene and inspection. Copyright 2008 John Wiley & Sons, Ltd. [source]

A survey of foot problems in juvenile idiopathic arthritis

G. Hendry BSc(Hons)
Abstract Background:,Evidence suggests that foot problems are common in juvenile idiopathic arthritis (JIA), with prevalence estimates over 90%. The aim of this survey was to describe foot-related impairment and disability associated with JIA and foot-care provision in patients managed under modern treatment paradigms, including disease-modifying anti-rheumatic drugs (DMARDs) and biologic therapies. Methods:,The Juvenile Arthritis Foot Disability Index (JAFI), Child Health Assessment Questionnaire (CHAQ), and pain visual analogue scale (VAS) were recorded in 30 consecutive established JIA patients attending routine outpatient clinics. Foot deformity score, active/limited joint counts, walking speed, double-support time (s) (DS) and step length symmetry index % (SI) were also measured. Foot-care provision in the preceding 12 months was determined from medical records. Results:,Sixty-three per cent of children reported some foot impairment, with a median (range) JAFI subscale score of 1 (0,3); 53% reported foot-related activity limitation, with a JAFI subscale score of 1 (0,4); and 60% reported participation restriction, with a JAFI subscale score of 1 (0,3). Other reported variables were CHAQ 0.38 (0,2), VAS pain 22 (0,79), foot deformity 6 (0,20), active joints 0 (0,7), limited joints 0 (0,31), walking speed 1.09,m/s (0.84,1.38,m/s), DS 0.22,s (0.08,0.26,s) and SI 4.0% (0.2,31.0%). A total of 23/30 medical records were reviewed and 15/23 children had received DMARDS, 8/23 biologic agents and 20/23 multiple intra-articular corticosteroid injections. Ten children received specialist podiatry care comprising footwear advice, orthotic therapy and silicone digital splints together with intrinsic muscle strengthening exercises. Conclusion:,Despite frequent use of DMARD/biologic therapy and specialist podiatry-led foot care, foot-related impairment and disability persists in some children with JIA. Copyright 2008 John Wiley & Sons, Ltd. [source]

Foot problems and effectiveness of foot care education in children and adolescents with diabetes mellitus

Mohd Hafiz Mohamad Rasli
Objectives:, To assess foot care in paediatric and adolescent patients with diabetes mellitus and to evaluate the effectiveness of foot care education given to participants. Research design and methods:, An 8-month prospective study of foot care in children and adolescents with type 1 and type 2 diabetes mellitus who attended diabetes clinics at the Royal Children's Hospital, Melbourne, where foot examination was performed at baseline and at follow-up. Patients and parents were given oral and written advice regarding foot care. Results:, Five hundred and fifty-seven patients were examined at baseline, and 312 patients were reviewed at follow-up 3,6 months later. The majority of foot problems found at first assessment were potentially modifiable disorders of skin and nails (68.8%). The remainder (31.2%) were structural musculoskeletal disorders requiring referral to a podiatrist/orthotist. A total of 532 foot problems were recorded at baseline in a cohort of 557 patients and 161 foot problems at follow-up of 312 patients. Significant reduction of modifiable foot problems was seen at follow-up, particularly in those with longer duration of diabetes and in those whose body mass index was higher. Conclusions:, This study highlights the importance of foot examination and foot care advice for children and adolescents with diabetes. Larger prospective studies are required to establish prevalence and to optimize preventive interventions. [source]

Validation of a new measure of protective footcare behaviour: the Nottingham Assessment of Functional Footcare (NAFF)

NB Lincoln PhD
Abstract There are no measures available to document footcare practice among people with diabetes and yet such measures are needed as a surrogate marker in studies designed to determine the effectiveness of footcare education. We have therefore developed such a measure, the Nottingham Assessment of Functional Footcare (NAFF), and have assessed its reliability and validity. A pilot questionnaire was distributed to people with diabetes and healthy controls, before being revised and shortened. The revised version was assessed for internal consistency and reliability. The pilot 51-item questionnaire was determined in 100 out-patients with diabetes and 61 healthy controls. The internal consistency was 0.46 in people with diabetes and 0.39 in healthy volunteers. Twenty-eight items showed significant differences between those with and without diabetes. The internal consistency and test,retest reliability of a revised version were determined in people with diabetes. The measure was further refined to a 29-item version, which had an internal consistency of 0.53. There was a significant correlation (rs 0.83; p<0.001) and no significant difference (p = 0.85) between scores in the test,retest study. Respondents with neuropathy scored significantly higher than those without (p<0.01). We conclude that the NAFF could act as an outcome measure in the prospective trials which are needed to establish the place of education programmes in clinical practice. The measure could also be used in routine care to identify those whose usual foot care might put their feet at risk of future ulceration. Copyright 2007 John Wiley & Sons. [source]

Long awaited formula for the improvement of foot care in diabetes

Louise Stuart MSc Consultant Podiatrist
No abstract is available for this article. [source]

Barriers to good diabetic foot care

30 June 200, A report from a Diabetic Foot Master Class, King's College Hospital, London
First page of article [source]

General medical practitioners in Pakistan fail to educate patients adequately about complications of diabetes

A major cause of concern for a developing country
Abstract The prevalence of diabetes in Pakistan is one of the highest reported worldwide. Proper education of patients regarding strategies to prevent complications of diabetes is an essential component of good management of diabetes. We conducted this study to determine the approach of general practitioners towards the management of diabetes. We carried out a cross-sectional survey of 100 randomly selected GPs from urban cities of Pakistan. A rigorously developed questionnaire was administered and contained questions on (1) diagnostic criteria, (2) health education, and management of a patient by non-pharmacological and (3) pharmacological treatment, and (4) appropriate referral of the patients to specialists. In total, 100 GPs were approached, and all consented to enrol; 70% were male. The average number of patients seen at each clinic was 30 patients per day. Only 38% of the GPs used the correct level of fasting blood glucose (,126mg/dl) as the cut-off for diagnosing diabetes. The majority of GPs did not adequately educate their patients. Only 65% of the GPs interviewed gave advice about exercise, 38% about weight reduction, 26% about foot care, 26% about the complications, 9% about insulin use, 20% about hypoglycaemic events, and 23% about smoking cessation. It was concluded that GPs in Pakistan under-diagnose and under-educate patients with diabetes. Our findings highlight the need for appropriate diagnosis and management of diabetes, and prevention of its complications. Copyright 2006 John Wiley & Sons, Ltd. [source]

Treading with care: foot care, litigation and the expert witness

JAS Foster BA (Hons) Barrister
Abstract This is a practical introduction to acting as an expert witness. The expert's report is an integral part of all litigation concerning allegations of professional negligence. A well-written report, embodying principles of sound academic research, is less likely to be challenged in court than a badly-prepared one. An expert should not hesitate to question his terms of reference if they are unclear or require widening. It is crucial to remember that the report is written for the benefit of the court, not the instructing party. In the witness box, the oath to tell the truth, the whole truth and nothing but the truth is paramount. It should be assumed that the Judge can grasp difficult medical concepts but may require fuller explanation than a fellow medical practitioner. It is important to answer the question that has been asked , but it is in order to disagree with a false premise. Appropriate concessions are more likely to impress the court than posturing. Each question should be treated on its merits. In conclusion, the role of the expert witness is demanding but application of these principles should make it a less daunting experience. Copyright 2004 John Wiley & Sons, Ltd. [source]

Ethnic and Sex Differences in Ownership of Preventive Health Equipment Among Rural Older Adults With Diabetes

Ronny A. Bell PhD
ABSTRACT:,Context:Diabetes self-management is important for achieving successful health outcomes. Different levels of self-management have been reported among various populations, though little is known about ownership of equipment that can enhance accomplishment of these tasks.Purpose:This study examined diabetes self-management equipment ownership among rural older adults.Methods:Participants included African American, American Indian, and white men and women 65 years of age and older. Data included equipment ownership overall and by ethnicity and sex across diabetes self-management domains (glucose monitoring, foot care, medication adherence, exercise, and diet). Associations between equipment ownership and demographic and health characteristics were assessed using logistic regression.Findings:Equipment ownership ranged from 85.0% for blood glucose meters to less than 11% for special socks, modified dishes, and various forms of home exercise equipment. Equipment ownership was associated with ethnicity, living arrangements, mobility, poverty status, and formal education.Conclusions:Rural older adults with diabetes are at risk because they lack equipment to perform some self-management tasks. Providers should be sensitive to and assist patients in overcoming this barrier. [source]