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At least 343 records · Page 19Linked to original sources

PubMed2003

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 (pound sterling 10.92) was found to be the same as for usual care (pound sterling 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.

Aged↗

PubMedDate not supplied

The effect of regular callus removal on foot pressures.

The optimum frequency of callus removal is unknown. This study shows that in-shoe dynamic plantar pressure measurement can quantify the effect of callus removal in relation with the frequency of podiatric treatment in diabetic ulcer patients. Three groups of diabetic neuropathic patients were studied. Group 0 consisted of six patients who presented for the first time ever for callus removal and who did not have a history of ulceration. The other two groups had a history of ulceration and required regular podiatry treatment: every 6-8 weeks for 10 patients in group A, and every 3-4 weeks for eight patients in group B. Peak plantar pressures were measured using the F-SCAN system, before and after removal of callus, which was weighed to further quantify the effect of podiatry. When callus was removed, peak pressures fell by 32.1 +/- 8.4% (p = .014) in group 0, by 30.9 +/- 4.5% (p < .005) in group A, and by 24.8 +/- 4.0% (p = .005) in group B. The mean weight of callus removed was not significantly different in the three groups. This suggests that the weight of callus is unlikely to be a reliable guide to assess the time intervals between podiatry appointments. However, the measurement of plantar pressures using a dynamic in-shoe plantar pressure device has proven to be a functional, objective, and quantifiable indicator in the assessment of podiatric treatment.

Adult↗

PubMed1999

Podiatric care for diabetic patients with foot problems: an observational study.

The aims of this study were to describe podiatric care for diabetic patients with foot problems and to explore the changes in knowledge, self-care behaviour and physical functioning after podiatric care. The treatment characteristics of 26 diabetic patients referred to podiatry were assessed. Prior to the first podiatric visit (T1) and 20 weeks later (T2) these patients filled in a structured questionnaire and performed a six-minute walking test. In half the number of patients preventive goals were set and strived for by general education about the diabetic foot and advice on footwear and self-care behaviour. With regard to treatment, reduction of pain was the most frequently selected goal. To achieve this reduction, a variety of interventions was applied. After podiatric care, patients reported having less severe foot pain and some improvements in functional ability and self-care behaviour were found. This study offers clues to start controlled clinical trials on the effectiveness of podiatry for diabetic patients. Trials should not only be directed to (the role of podiatry in) ulcer healing; it may be even more significant to study its effectiveness for the purpose of prevention and treatment of early-stage diabetic foot symptoms.

Activities of Daily Living↗

PubMed2000

Interventions for treating plantar heel pain.

BACKGROUND: Ten percent of people may experience pain under the heel (plantar heel pain) at some time. Injections, insoles, heel pads, strapping and surgery have been common forms of treatment offered. The absolute and relative effectiveness of these interventions are poorly understood. OBJECTIVES: The objective of this review was to identify and evaluate the evidence for effectiveness of treatment in treating plantar heel pain. SEARCH STRATEGY: MEDLINE (from 1966 to December 1997), EMBASE and the Cochrane Library were searched. Three podiatry journals (The Foot, The Chiropodist (later The Journal of British Podiatric Medicine), and The British Journal of Podiatric Medicine) were handsearched. We contacted known investigators in the field to identify unpublished data or research in progress. Non English language reports were excluded from the review. SELECTION CRITERIA: Randomised and quasi randomised trials of interventions for plantar heel pain in adults. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated studies for inclusion, extracted data and assessed study quality. Additional information was obtained by direct contact with investigators. No poolable data were identified. Where measures of variance were available we have calculated the weighted mean differences based on visual analogue scale (VAS) scores. MAIN RESULTS: Eleven randomised trials involving 465 participants were included. Study quality was generally poor, and pooling of data was not possible. All studies measured a reduction in heel pain as the primary outcome. Seven trials evaluated interventions against placebo/dummy or no treatment. There was limited evidence for the effectiveness of topical corticosteroid, administered by iontophoresis in reducing pain. There was no evidence for the effectiveness of injected corticosteroid. There was limited evidence for the effectiveness of low energy extracorporeal shock wave therapy in reducing night pain, resting pain and pressure pain in the short term (12 weeks). In individuals with chronic pain (longer than six months), there was limited evidence for the effectiveness of dorsiflexion night splints in reducing pain. There was no evidence to support the effectiveness of therapeutic ultrasound, low-intensity laser therapy, exposure to an electron generating device or insoles with magnetic foil. No randomised trials evaluating orthotic devices, surgery, or radiotherapy against a control population were identified. There was limited evidence for the superiority of corticosteroid injections over orthotic devices. REVIEWER'S CONCLUSIONS: Although there is limited evidence for the effectiveness of local corticosteroid therapy, the effectiveness of other frequently employed treatments in altering the clinical course of plantar heel pain has not been established in comparative studies. Well designed and conducted randomised studies are required.

Adrenal Cortex Hormones↗

PubMed1997

Colonization of skin by Helcococcus kunzii.

In order to investigate the role of Helcococcus kunzii as a colonizer of skin and as a possible participant in diabetic foot ulcers, we used a selective medium to culture both lower- and upper-extremity skin from a study group of podiatry patients (60 diabetics and 60 nondiabetics) and a control group of 50 healthy volunteers. Although differences in colonization were not statistically significant, a trend toward higher colonization rates in the group of podiatry patients was noted. H. kunzii appears to preferentially colonize the skin of the feet, and while its pathogenic role in diabetic foot ulcers is difficult to establish, it may be a previously unrecognized component of the polymicrobial flora characteristically isolated from patients with these infections.

Diabetes Mellitus, Type 1↗

PubMed1989

Forensic methods and the podiatric physician.

This is an introductory study of forensic podiatry. To elevate forensic podiatry to the level of forensic odontology and forensic anthropology, the podiatric medical profession must begin educational programs and research. A system for monitoring the activities of podiatrists involved in forensic medicine must be established to ensure that the high degree of integrity to which the profession is committed is maintained. By following these guidelines, the author believes that sometime in the future a podiatrist will be on the staff of every major police department in the country. At that point, the podiatric medical profession will have achieved unsurpassed status, recognition, and prestige.

Forensic Medicine↗

PubMed1992

Podiatric utilization referral patterns at an Army medical center.

Presented is the first descriptive data on a large military Podiatry Clinic supporting largely combat troops. Data consist of initial podiatric problems of soldiers and other beneficiaries of podiatric care. Demographic, physician referral patterns, and other pertinent summarized survey information of outpatient utilization at the Podiatry Clinic, Madigan Army Medical Center, Fort Lewis, Washington, are examined. Findings are based on new and initial consult referrals from the month of November 1988. The results indicated that some clinics needed inservices and further education concerning podiatric care. This study has led to the implementation of changes which have resulted in better and more timely patient care.

Adolescent↗

PubMed2002

Oral treatments for fungal infections of the skin of the foot.

BACKGROUND: About 15% of the population have fungal infections of the feet (tinea pedis or athlete's foot). Whilst there are many clinical presentations of tinea pedis the most common are between the toes (interdigital) and on the soles, heels and sides of the foot (plantar) which is known as moccasin foot. Once acquired the infection can spread to other sites including the nails, which can be a source of reinfection. Oral therapy is usually used for chronic conditions or when topical treatment has failed. OBJECTIVES: To assess the effects and costs of oral treatments for fungal infections of the skin of the foot (tinea pedis). SEARCH STRATEGY: Randomised controlled trials were identified from MEDLINE, EMBASE and CINAHL from the beginning of these databases to January 2000. We also searched the Cochrane Controlled trials Register (Cochrane Library issue 1, 2000) the Science Citation Index, BIOSIS, CAB-Health, Health star and Economic databases. Bibliographies were searched, podiatry journals hand searched and the pharmaceutical industry and schools of podiatry contacted. SELECTION CRITERIA: Randomised controlled trials including participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes in culture. DATA COLLECTION AND ANALYSIS: Study selection was done by two independent reviewers. Methodological quality assessment and data collection was also assessed by two independent reviewers. MAIN RESULTS: Twelve trials, involving 700 participants, were included. The two trials comparing terbinafine and griseofulvin produced a pooled risk difference of 52% (95% confidence intervals 33% to 71%) in favour of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole; fluconazole and either itraconazole and ketoconazole; or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo. Adverse effects were reported for all drugs, with gastrointestinal effects most commonly reported. REVIEWER'S CONCLUSIONS: The evidence suggests that terbinafine is more effective than griseofulvin and that terbinafine and itraconazole are more effective than no treatment.

Administration, Oral↗

PubMedDate not supplied

The diabetic foot: a global view.

It is estimated that approximately 15% of the more than 150 million people with diabetes world-wide will at some stage develop diabetic foot ulceration. Foot problems are indeed a global problem and there is no area in the world that does not report the development of foot lesions as a consequence mainly of neuropathy and peripheral vascular disease. The prevalence of active foot ulceration varies from approximately 1% in certain European and North American studies to more than 11% in reports from some African countries. Although there have been many developments in recent years which encourage optimism for future improvement in diabetic foot care, there is still much to be done; the recent data from the Netherlands show that with a concerted team approach, it is possible to increase the numbers of foot clinics with the provision of podiatry services by more than 100%. However, many countries still lack proper podiatry and specialist nursing provision and there remains much to be done in the next millennium to improve the lot of the diabetic patient with foot problems.

Africa↗

PubMed2002

Association of British Clinical Diabetologists (ABCD) survey of secondary care services for diabetes in the UK, 2000. 1. Methods and major findings.

OBJECTIVE: To examine the provision, and variations in, secondary care diabetes services in the UK. METHODOLOGY AND PARTICIPANTS: A postal survey of all 238 identified secondary care providers of diabetes services in 2000. RESULTS: Following two reminders, a 77% response rate was achieved. Major deficiencies in core staffing levels were recorded, with 36% of services provided by only one consultant physician with an interest in diabetes. The provision of diabetes specialist nurses was less than recommended in 87% of responses, whereas podiatry and dietetic support was unavailable in 3% and 27% of responses, respectively. Diabetes registers were not present in 28%, and a co-ordinated retinopathy screening programme unavailable in 26% of responses. Key biochemical measurements were unavailable in 9% (microalbuminuria) to 18% (HDL-cholesterol) of responses. A 'Well-Resourced Service' score was devised taking account of levels of personnel, facilities and specialized clinical services. There was a significant geographical variation in this score (P < 0.001), with the lowest score (least well-resourced services) in the Eastern NHS Region of England, and the highest score in the North-west NHS Region of England. The 'Well-Resourced Service' score was also significantly lower (P < 0.05) where there were less than two whole-time consultant physicians providing diabetes services. In contrast to other aspects of service provision, availability of dieticians and a combined diabetes-ophthalmology service had declined since 1990. Of 245 recorded bids for resources and service improvements for diabetes care, the success rate overall was 44%, and lowest where bids were made for dietetic and podiatry support. CONCLUSIONS: There is presently a major shortfall in provision of secondary care diabetes services throughout the UK, with evidence that there is significant regional variation and less facilities and resources where there are less than two consultants providing specialized diabetes services. On average bids for service improvements were only successful in < 50% of cases, most usually where the service was relatively better provided for. Considerable development and investment are required nationally to ensure equitable access to specialized diabetes services, a vital component in reducing adverse diabetes outcomes.

Delivery of Health Care↗

PubMed1995

Reduction of gangrene and amputations in diabetic renal transplant patients: the role of a special foot clinic.

This 4-year prospective study investigated the reasons for high levels of gangrene and major amputation in diabetic renal transplant patients and whether regular multidisciplinary foot care could reduce morbidity. All foot lesions were documented and investigated in 50 diabetic patients, mean age 49.2 +/- 11.0 (SD) years, duration of diabetes 25.3 +/- 9.0 years, time since renal transplantation 60.2 +/- 35.1 months, who attended a special foot clinic monthly for education, vascular and neurological assessment, podiatry and footwear. Foot lesions included: neuropathic ulcers, ischaemic ulcers, traumatic lesions, Charcot's arthropathy, pathological fracture. Treatment included antibiotics, podiatry, footwear, and angioplasty or distal bypass where appropriate. Only 13 patients were deemed ischaemic but peripheral neuropathy was a very common finding (mean VPT 24.8 +/- 12.9 V). Gangrene and major amputations showed a decrease on previous years and healing times for lesions were similar to those previously reported in diabetic patients without renal transplants. The majority of foot lesions, both in soft tissue and bone, were related to neuropathy and trauma and responded well to optimal foot care within the renal unit. Gangrene and major amputations were usually preventable.

Ambulatory Care Facilities↗

PubMed2003

[Systematic treatment of tinea pedis--evidence for treatment? A result of a Cochrane review].

BACKGROUND: About 15% of the population have fungal infections of the feet (tinea pedis or athlete's foot). Whilst there are many clinical presentations of tinea pedis the most common are between the toes (interdigital) and on the soles, heels and sides of the foot (plantar) which is known as moccasin foot. Once acquired the infection can spread to other sites including the nails, which can be a source of reinfection. Oral therapy is usually used for chronic conditions or when topical treatment has failed. OBJECTIVES: To assess the effects and costs of oral treatments for fungal infections of the skin of the foot (tinea pedis). SEARCH STRATEGY: Randomised controlled trials were identified from MEDLINE, EMBASE and CINAHL from the beginning of these databases to January 2000. We also searched the Cochrane Controlled trials Register (Cochrane Library issue 1, 2000) the Science Citation Index, BIOSIS, CAB-Health, Health star and Economic databases. Bibliographies were searched, podiatry journals hand searched and the pharmaceutical industry and schools of podiatry contacted. SELECTION CRITERIA: Randomised controlled trials including participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes in culture. DATA COLLECTION AND ANALYSIS: Study selection was done by two independent reviewers. Methodological quality assessment and data collection was also assessed by two independent reviewers. MAIN RESULTS: Twelve trials, involving 700 participants, were included. The two trials comparing terbinafine and griseofulvin produced a pooled risk difference of 52% (95% confidence intervals 33% to 71%) in favour of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole; fluconazole and either itraconazole and ketoconazole; or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo. Adverse effects were reported for all drugs, with gastrointestinal effects most commonly reported. REVIEWERS' CONCLUSIONS: The evidence suggests that terbinafine is more effective than griseofulvin and that terbinafine and itraconazole are more effective than no treatment.

Antifungal Agents↗

PubMedDate not supplied

Anterior ankle arthroplasty: a retrospective study.

A retrospective analysis of surgical resection of symptomatic tibiotalar impingement exostosis was performed at the Podiatry Hospital of Pittsburgh. Thirty-four patients with a postoperative follow-up ranging from 17 to 97 months, with an average of 36 months were studied. The study has demonstrated an 88% satisfaction rate with patients who sustained anterior ankle arthroplasty at The Podiatry Hospital of Pittsburgh.

Adult↗

PubMedDate not supplied

First metatarsocuneiform joint arthrodesis: a five-year retrospective analysis.

Historically, first metatarsocuneiform joint arthrodesis has been advocated for severe metatarsus primus adductus deformity and as a salvage procedure in reconstructive forefoot surgery. At the Podiatry Hospital of Pittsburgh, the authors have expanded the use of this procedure to include elimination of excessive motion at the first metatarsocuneiform joint and to restore functional integrity to the first ray in an otherwise poorly functioning foot. First metatarsocuneiform arthrodesis has had poor acceptance by podiatric surgeons. Common reasons for this poor acceptance are technical difficulty associated with the procedure and often-cited complications such as shortening of the first ray, with symptomatic transfer lesions, as well as nonunion of the arthrodesis site. The authors evaluated 54 procedures. Results of first metatarsocuneiform joint arthrodesis for long-term reduction of the intermetatarsal angle and for limiting abnormal motion at this joint have been very good. Few complications were encountered. Shortening of the first metatarsal with secondary transfer lesions was not found to be a common problem. Several radiographic nonunions occurred, none of which were symptomatic. The surgical procedure, as it is performed at the Podiatry Hospital of Pittsburgh, is described. Results from a 5-year retrospective analysis of first metatarsocuneiform arthrodesis are presented.

Adolescent↗

PubMed2007

Teaching during rounds.

Teaching rounds are a vital part of every residency program. Patient rounds provide an avenue to incorporate evidence-based medicine, current literature, and personal experiences into daily teaching while allowing residents to experience the doctor-patient relationship. Although time consuming, daily in-patient rounds are invaluable to any physician's training. This article discusses how to conduct well-organised, efficient patient rounds with maximum learning benefits for the residents. The daily protocol followed by the Podiatry Service at University Hospital, University of Medicine and Dentistry of New Jersey is also described. Conducting beneficial teaching rounds is an important aspect of a residency program when developing highly competent physicians.

Evidence-Based Medicine↗

PubMed2000

Case study to illustrate a multidisciplinary approach to a case of critical limb ischaemia and the role of chemical lumbar sympathectomy.

This case study illustrates the role of the Podiatrist in the primary health care team and how a multidisciplinary approach to treatment promotes successful diagnosis and treatment regimes. It also outlines the role for chemical lumbar sympathectomies in treating critical lower limb ischaemia, a procedure regarded as having been superseded by more effective treatments but which proved to be the treatment of choice in this case. The subject of this case study presented at a community podiatry clinic exhibiting the signs of acute ischaemia, together with two recently developed ulcers on her right foot. After further vascular investigations, including angiograms and doppler studies, a blockage in the popliteal artery was revealed. Due to anatomically slender arteries, angioplasty and by-pass surgery were contra indicated. A chemical lumbar sympathectomy was performed in an attempt to increase blood flow to the tissues and to reduce the extreme pain being experienced by the patient. This proved successful, allowing the lesions to heal and also the collateral circulation to develop, resulting in a re-vascularized, viable foot.

Female↗

PubMed1982

Podiatric Surgery: the need for a second opinion.

A second-opinion podiatry program, designed to contain costs and enhance the quality of care, was established in the greater New York City area by the Building Service Employees' Health Fund. All nonemergency foot surgery recommended by a podiatrist that cost over $100 was included in this program. Of the 363 individuals who had a second opinion, 82 per cent were confirmed for surgery; however, the confirmation rate among those seeing a podiatrist serving as consultant was 94.3 per cent, while the confirmation rate of those seeing an orthopedists serving as consultant was 49.5 per cent. For every condition, the podiatrists overwhelmingly confirmed the need for surgery. Conversely, the orthopedists were more conservative in their recommendations regarding surgery. The program's cost was $311,813. If a second opinion consultation wasn't required for removal of corns or ingrown toenails, the total would be much less. It seems sensible (economically and medically) to encourage or require a consultation with an orthopedist for conditions such as bunions, hammertoes and heel spurs, and not to require a second opinion consultation for superficial podiatric conditions such as corns and ingrown toenails, which are treated predominantly by the podiatrist.

Adolescent↗

PubMed2001

What is the association between the different components of stroke rehabilitation and health outcomes?

OBJECTIVES: To describe the rehabilitation input stroke patients received from health professionals during the early post stroke period and to explore possible associations between health outcomes and these rehabilitation inputs. DESIGN: Community-based study with prospective identification of stroke patients from a random sample of 24 general practices stratified by geographical area and practice size. SETTING: Ayrshire and Arran Health Board area, West of Scotland. INTERVENTIONS: All physiotherapy, occupational therapy, dietetics, podiatry, speech and language therapy and community nursing inputs given to stroke patients in the course of normal treatment were recorded. OUTCOME MEASURES: Barthel Index and Medical Outcomes Study Short Form-36 (SF-36). Both recorded at one, three and six months post stroke. RESULTS: Of the 152 people providing data, more had received physiotherapy than any other rehabilitation input at all three follow-ups (81%, 47%, 39%), with occupational therapy being the next most common service (65%, 44%, 25%). Amount of rehabilitation input was significantly negatively correlated with health outcomes measured at each discrete time point: those patients with the poorest outcomes received greatest input. However, regression analysis of change in outcome scores showed that increasing amounts of rehabilitation input were significantly associated with a reduction in disability, particularly between one and three months post stroke. CONCLUSIONS: Not only have we shown that those stroke patients with poorest outcomes received most rehabilitation input, but, from analysis of the individual rehabilitation inputs, we have identified some rehabilitation inputs that significantly predict improved outcomes. This suggests that there would be merit in further investigation of these associations.

Activities of Daily Living↗