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At least 19 recordsLinked to original sources
PubMed2002

Diabetic foot disease and foot care in a Caribbean community.

We estimated the prevalence of foot symptoms and disease and evaluated foot care practices in a primary care based sample including 2106 people with diabetes in Trinidad. Symptoms of neuropathy were reported by 1030 (49%), previous foot ulceration by 257 (12%), and amputation by 92 (4%). Previous foot ulceration was associated with longer duration of diabetes (odds ratio 1.05, (95% CI 1.04-1.06) per year) and greater severity of neuropathy symptoms (1.17 (1.10-1.24) per unit increase in score). A history of foot ulceration gave relative odds of amputation of 16.3 (8.1-32.9). In those with previous foot ulceration, 120 (47%) went barefoot in the home, and 44 (17%) went barefoot outside the house. Overall, 1491 (71%) subjects reported they cut their toenails themselves, help was provided by a friend or relative to 584 (28%) and by a nurse or chiropodist to 13 ( < 1%). Most patients (1320, 63%) reported that they would treat a cut or blister on the foot themselves, while only 650 (31%) would attend for health care. Diabetic foot disease is common but care practices predispose to foot injury. Implementation of a strategy to improve care of the feet is needed.

Amputation, Surgical↗
PubMed2005

The global burden of diabetic foot disease.

Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes in the next 20 years. People at greatest risk of ulceration can easily be identified by careful clinical examination of the feet: education and frequent follow-up is indicated for these patients. When assessing the economic effects of diabetic foot disease, it is important to remember that rates of recurrence of foot ulcers are very high, being greater than 50% after 3 years. Costing should therefore include not only the immediate ulcer episode, but also social services, home care, and subsequent ulcer episodes. A broader view of total resource use should include some estimate of quality of life and the final outcome. An integrated care approach with regular screening and education of patients at risk requires low expenditure and has the potential to reduce the cost of health care.

Amputation, Surgical↗
PubMed1993

Preventing diabetic foot disease.

Diabetic foot disease results from two common pathologies: peripheral vascular disease and diabetic neuropathy. If these pathologies are not identified, ulceration may occur in the foot. Ulcers can lead to infection and finally amputation. This article discusses the components of the physical exam, current treatment for both pathologies, and client education. Because the two pathologies are similar in presentation, it is important for clinicians to distinguish between the two pathologies. Careful attention to the feet during the physical exam and assessment for symptoms can help distinguish the two pathologies. There are new treatments available for peripheral vascular disease to improve the client's circulation. Treatment of peripheral neuropathy is usually palliative, but can improve the client's quality of life. Through early identification and treatment of peripheral vascular disease and diabetic neuropathy, clients with diabetes can avoid ulceration. Client education is central to the treatment plan.

Diabetic Angiopathies↗
PubMed2005

The effects of foot disease on quality of life: results of the Achilles Project.

BACKGROUND: Foot diseases have a high prevalence in the general population, but their impact on quality of life has not been assessed in large-scale studies. The Achilles Project surveyed foot disease in patients visiting their primary care physician or dermatologist. METHODS: A total of 43 593 patients were asked about the impact of their condition on their quality of life: pain, discomfort in walking, limitations in daily activities, and embarrassment. RESULTS: Overall, 52.5% of patients had some aspect of their quality of life affected by their foot disease. More specifically, 30.7% of patients experienced pain, 40.3% had discomfort in walking, 19.6% had their daily activities limited, and 27.3% were embarrassed. The survey indicated a larger impact of foot disease on the quality of life of women vs. men in all categories, except for daily activities. Similarly, the elderly (> or = 65 years) were more affected by their foot disease, although they suffered no more embarrassment than other age groups. Participation in sports seemed to lower the proportion of patients who had their quality of life adversely affected. Non-fungal foot diseases, particularly ulcer and gangrene, are more likely to cause pain, discomfort in walking and limit daily activities, than fungal diseases. CONCLUSIONS: In general, non-fungal foot diseases caused pain, discomfort in walking and limitations in daily activities in more patients than fungal foot diseases, but a higher proportion of patients with fungal foot diseases were embarrassed by their condition than patients with non-fungal foot diseases. The study found that the impact of foot disease on quality of life may be greater than previously suggested. Given that effective treatments are available, routine examination of patients' feet by dermatologists and primary care physicians may help to reduce the burden of these foot conditions.

Activities of Daily Living↗
PubMed2003

High prevalence of foot diseases in Europe: results of the Achilles Project.

OBJECTIVE: To provide an insight into the prevalence of foot disease in Europe, and to include an assessment of the prevalence of predisposing factors and their correlation with foot disease. DESIGN: Large population-based survey conducted in 16 European countries. SETTING: The project consisted of two parts (study I and study II), in which all patients presenting to general practitioners and dermatologists over a defined time period were invited to participate. Patients. In study I, 70,497 patients presenting to dermatologists or general practitioners were recruited, and in study II 19,588 patients presenting to dermatologists were recruited. MAIN OUTCOME MEASURE: The feet of all participants were examined for signs of foot disease. The assessors also recorded relevant details such as the age and sex of patients, and the presence of predisposing factors for foot disease. In addition, patients in study II were offered a free mycological examination of the toenails and skin on the feet. RESULTS: In study I, 57.0% of patients had at least one foot disease. In study II, 61.3% had at least one foot disease. The proportions of patients with fungal foot disease and non-fungal foot disease in study I were 34.9% and 38.4%, respectively, and in study II were 40.6% and 41.7%, respectively. Orthopedic conditions and metatarsal corns were the most frequently reported non-fungal foot diseases, and onychomycosis and tinea pedis were the most frequently observed fungal infections. CONCLUSIONS: This large-scale survey suggests that the prevalence of fungal and non-fungal foot disease is higher than previously estimated.

Adult↗
PubMed1996

Foot pathology and risk factors for diabetic foot disease in elderly men.

We examined 3 groups of elderly men; men with diabetes and previous or present foot ulcers, men with diabetes, and men without diabetes. In the foot diseased group, diabetes duration was longer (18 +/- 11 vs 8 +/- 7 years), insulin treatment was more common (86% vs 7%), fasting blood glucose and HbA1c were significantly higher (10.5 +/- 4.0 mmol/1, 8.4% +/- 1.6%) than in the diabetic control group (8.3 +/- 3.4 mmol/l, 7.4 +/- 1.7%). Men in the foot diseased group were taller than men in the diabetic group and non-diabetic men (1.79 vs 1.74 m) but not more obese (BMI 26-27 kg/m2 in all three groups). Current or previous alcoholic problems were more common in the foot diseased group (32%) compared to the control diabetic group (9%) and the non-diabetic group (10%). Diabetic patients with known foot disease had more often callosities, absent hair growth, dry skin and redness, compared to the other groups. Psychosocial problems (alcohol and divorce), long standing diabetes duration and poor metabolic control seem to be of importance for the development of diabetic foot ulcers.

Aged↗
PubMed1986

A critical review of epidemiologic studies on black-foot disease.

An endemic disease in Taiwan named "Black-foot Disease", which has been researched since 1958 and about which many papers have been published, was considered caused by arsenic poisoning from artesian well water. In the beginning some information related to the disease before 1958 is introduced and then, reviews of the six papers titled "Epidemiologic Studies" on "Black-foot Disease" are made without referring to any findings from other papers. The data related to the incidence and severity of the disease from the papers are reevaluated, paying special attention to the fact that the incidence of the disease increased after the installation of pipe system water-supply to replace the artesian wells. With the above-mentioned result the theory which considers arsenic poisoning as the cause of the disease, is disproved.

Arsenic Poisoning↗
PubMed2002

A prospective epidemiologic survey on the prevalence of foot disease in Hong Kong.

A prospective epidemiologic survey on the prevalence of foot disease in Hong Kong found foot disease in 64% of patients screened. All of the patients were ethnically Chinese. Of the conditions specified in the questionnaire, fungal foot infection, tinea pedis, and toenail onychomycosis were the most frequently encountered conditions, followed by metatarsal corns, eczema, psoriasis, and pes planus. Vascular disease, osteoarticular pathology, diabetes mellitus, obesity, atopy, and participation in sports were the main factors coexisting with the foot conditions. Of the study population, 17% and 21% reported that their quality of life was affected by pain and discomfort, respectively. These percentages are much lower than those obtained in other studies; it may therefore be inferred that foot complaints are being neglected by the ethnic Chinese population in Hong Kong.

Adolescent↗
PubMedDate not supplied

An overview of foot disease in patients with diabetes.

Effective management of diabetic foot disease requires a multidisciplinary approach and good communication between all healthcare professionals involved. This article provides an overview of the main factors that need to be considered when assessing patients with diabetic foot disease.

Aged↗
PubMed1998

Hospital discharges for diabetic foot disease in New Zealand: 1980-1993.

The aim of this study was to determine the prevalence of hospital discharges for diabetic foot disease from 1980 to 1993 in New Zealand and identify regional variations. Data from the International Classification of Disease (ICD) discharge codes for diabetes and its complications from 1980 to 1993 were reviewed for diabetic foot disease. The total number of discharges/100,000 total population has increased from 13.56 in 1980 to 25.79 in 1993. The age and sex-standardised total bed/days per 1000 total population increased from 5.02 in 1980 to 5.85 in 1993. The total inpatient cost for the management of diabetic foot disease in New Zealand (population 3.3 million) for 1993 is estimated to be in the region of NZ$10-11 million (USD$7-7.7 million), indicating the need to put strategies in place to manage this problem. Strategies that reduce the individual and inpatient burden of this advanced stage complication of diabetes mellitus can be implemented easily for a relatively modest cost.

Adult↗
PubMed2006

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study.

AIMS/HYPOTHESIS: Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries. METHODS: The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October 2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection: A: PAD -, infection -; B: PAD -, infection +; C: PAD +, infection -; D: PAD +, infection +. RESULTS: PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease. Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and more serious comorbidity. CONCLUSIONS/INTERPRETATION: According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease. Further research is needed to obtain insight into the clinical outcome of these patients.

Aged↗
PubMedDate not supplied

Diabetic foot disease.

OBJECTIVE: To review the spectrum of foot problems in patients with diabetes and the underlying etiologic factors. METHODS: In this review, the term "diabetic foot disease" (DFD) will be used (previously referred to as simply "diabetic foot"). The relevant anatomy of the foot is discussed, the clinical evaluation and severity of DFD are outlined, and the role of both systemic control and local measures in the management of DFD is addressed. RESULTS: DFD is linked with a wide variety of etiologic associations, pathologic forms, and clinical severity. The causes of DFD include such factors as diabetic neuropathy, vascular insufficiency, and the presence of underlying bone deformity. The pathologic forms range from superficial skin lesions, soft tissue infections, joint swellings, and deformities to frank necrosis and gangrene. The clinical severity ranges from mild, self-resolving disease to fulminant, rapidly progressive disease that usually eventuates in amputation. The heterogeneity of patients whose illness is grouped collectively under the diagnosis of DFD has contributed to the persisting confusion and controversy regarding the optimal classification system for diabetes-related foot problems and their appropriate management. CONCLUSION: Optimal management of DFD involves a multimodality approach directed at regular foot care, blood glucose control, and early recognition of foot problems. Appropriate surgical management, administration of systemic antibiotics, and off-loading techniques are necessary to prevent the progression of DFD.

Coronary Disease↗
PubMed1993

The incidence of bladder cancer in the black foot disease endemic area in Taiwan.

A high incidence of bladder cancer (23.53/100,000 population per annum from 1981-1985) was found in an endemic area of peripheral vascular disease known as black foot disease (BFD) on the southwest coast of Taiwan. The average incidence of bladder cancer in the whole of the Taiwan area was 2.29/100,000 during the same period. The incidence of female bladder cancer (21.10/100,000) in this area was also high. The ratio of male to female bladder cancer in the BFD endemic area and the neighbouring area was 1.24 and 1.09, lower than that in the whole Taiwan area (2.75) and elsewhere around the world. The high content of arsenic and the high concentration of a "fluorescent substance" in artesian well water in this area are the only 2 related factors identified so far. Determination of the actual carcinogen requires further investigation.

Female↗
PubMed2001

Evaluation of arterial obstructive leg and foot disease by three-phase bone scintigraphy.

BACKGROUND: The level selected for amputation should generally be the lowest compatible with tissue viability, with a reasonable expectation of wound healing in patients with arterial obstructive leg and foot disease, but determining the amputation level of an ischemic lower limb remains controversial. The general consensus is that a decisive and final decision about the amputation level should be made intraoperatively based on the extent of hemorrhage from the incised skin and soft tissue, and the degree of viability of the stump. OBJECTIVE: To estimate the extent of such hemorrhage, and thus suggest the level of amputation preoperatively, the author applied three-phase bone scintigraphy (TPBS) to assess the blood flow in the small arteries and capillary vessels. METHOD: TPBS was performed in patients scheduled to undergo lower limb amputation in an attempt to determine the appropriate amputation level preoperatively, objectively, and visually. Imaging results of this examination were compared with the clinical findings in three cases of arterial obstructive foot disease. RESULTS: The "capillary phase" depicted the perfusion of blood from the small arteries to the capillary vessels. Decreased accumulation in the capillary phase appeared as two distinctive states: one of clinically remarkable necrosis and the other of decreased blood flow in the small arteries and capillary vessels. The latter inevitably causes necrosis and infection postoperatively. CONCLUSION: The results of this study suggest that TPBS is an extremely useful tool in the evaluation of physiological dysfunction and the likely amputation level in patients with arterial obstructive leg and foot disease.

Amputation, Surgical↗
PubMed1993

The effect of intravenous infusion of prostaglandin E1 on cutaneous microcirculation in black foot disease.

In order to evaluate the effect of an intravenous infusion of prostaglandin E1 (PGE1), 80 micrograms/day for two weeks, on microcirculatory vasculature in seven patients (M:F = 3:4, age 60-78) with black foot disease (a peripheral vascular disease of undefined etiology), we applied laser Doppler velocimetry to measure the maximal cutaneous microcirculatory flow (LDF) at a proximal site near gangrenous ulcers of the foot. Maximal flow was induced by local warming to 42 degrees C with a modified laser Doppler heating probe. Three phasic measurements were recorded, i.e., during pretreatment, treatment and follow-up with the separation interval being two weeks. The net maximal LDF (LDF at 42 degrees C minus LDF at room temperature) increased from 8.8 +/- 4.0 to 11.9 +/- 4.0 volt, p < 0.05. Cutaneous vascular conductance (CVC) was calculated as LDF/mean BP. Mean BP showed no significant change before or after treatment. Net CVC was changed from 7.5 +/- 3.1 to 11.9 +/- 4.0 volt/100 mmHg, p < 0.05. The LDF dropped significantly during the two-week period between treatment and follow-up in five subjects (10.8 +/- 3.4 vs 4.6 +/- 1.8, p < 0.05), while the follow-up LDF was close to the control data (4.6 +/- 1.8 vs 6.3 +/- 2.2, p = NS). Hence, we conclude that PGE1 may beneficially enhance microcirculatory blood flow in black foot disease through direct vasodilatory effects.

Aged↗
PubMed1994

Mutational spectrum in the p53 gene in bladder tumors from the endemic area of black foot disease in Taiwan.

An elevated risk of bladder cancer has been reported in the endemic region of 'black foot disease' on the southwest coast of Taiwan and may be related to high arsenic levels in artesian well water. Thirteen urothelial tumors from this endemic region were examined for mutations in exons 5-8 of the p53 gene to identify the effects of possible exogenous factors at the DNA level. DNA was extracted from archival tissue after microdissection of tumors and analyzed by PCR-SSCP (polymerase chain reaction-based single strand conformation polymorphism), followed by direct sequencing. Eight cases (62%) showed mutations and 9 of the 10 point mutations observed were transitions. The type and position of the mutations were not significantly different when compared with the spectra of p53 mutations previously reported for transitional cell carcinomas (TCCs). However, two of the mutations were CGC-->CAC base changes at codon 175, a mutational hotspot for many tumor types but previously unreported in TCCs except in cases associated with inflammatory agents. Three of the tumors examined were found to contain double mutations, a relatively rare mutagenic event in human cancers. Our results suggest that the agents responsible for the high risk of bladder cancer in the black foot disease region may operate through an inflammation-based mechanism which increases the amount of DNA damage per mutagenic event.

Adult↗
PubMedDate not supplied

Pattern and management approach of diabetic foot disease in a developing country.

BACKGROUND: Diabetes mellitus is a common endocrine illness in our environment. Diabetic foot gangrene is its commonest surgical complication and is a health burden in Niger Delta region of Nigeria. The aim of the study was to highlight the demography, bacterial incidence, time frame to development of diabetic foot, reaction to ablative surgery and the use of San Antonio wound classification system forthe treatment decision. METHODS: We retrospectively reviewed 46 diabetic feet in 41 diabetics over a 5 year period, January 1999 to December 2003, using the San Antonio classification system. The case notes of all patients seen in the University of Port Harcourt Teaching Hospital were included in the study. RESULTS: There were 32 males and 9 females with a male female ratio of 3.6:1. The age range was 34 to 90 years with a mean of 56 +/- 12 years. The mean duration between diagnoses of diabetes mellitus and development of foot disease was 13 +/- 5 years. Twenty four patients (59.5%) with stages A or B irrespective of the grade had a chance of limb salvage using appropriate antibiotic, serial wound debridement, regular dressing and skin grafting where necessary. Of the 24, 3 absconded, 5 died and 16 healed and were discharged. The remaining 17 patients (40.5%) were stages C and D and were offered ablative surgery irrespective of the grade. Nine discharged against medical advice, 5 died and 3 were discharged in good condition. CONCLUSION: This is a disease of the older population. Delay in accepting ablative surgery affects prognosis. Outcome in management of diabetic foot disease can be improved by education, early presentation, funding for establishment of specialized diabetic foot clinics and early decisive definitive management.

Adult↗