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At least 55 records · Page 3Linked to original sources
PubMed2005

Foot ulcer risk is lower in South-Asian and african-Caribbean compared with European diabetic patients in the U.K.: the North-West diabetes foot care study.

OBJECTIVE: To determine 1) foot ulcer rates for European, South-Asian, and African-Caribbean diabetic patients in the U.K and 2) the contribution of neuropathy and peripheral arterial disease (PAD) differences to altered ulcer risk between the groups. RESEARCH DESIGN AND METHODS: In this U.K. population-based study, we screened 15,692 type 1 and type 2 diabetic patients in the community health care setting for foot ulcers, foot deformities, neuropathy, and PAD plus other characteristics. In total, 13,409 were European (85.5%), 1,866 were South Asian (11.9%), and 371 were African Caribbean (2.4%). RESULTS: The age-adjusted prevalence of diabetic foot ulcers (past or present) for Europeans, South Asians, and African Caribbeans was 5.5, 1.8, and 2.7%, respectively (P < 0.0001). Asians and African Caribbeans had less neuropathy, PAD, and foot deformities than Europeans (P = 0.003). The unadjusted risk of ulcer (odds ratio [OR]) for Asians versus Europeans was 0.29 (95% CI 0.20-0.41) (P < 0.0001). PAD, neuropathy, foot deformities, and insulin use attenuated the age-adjusted OR from 0.32 to 0.52 (0.35-0.76) (P < 0.0001). African-Caribbean versus European ulcer risk in males was attenuated from 0.60 to 0.71 by vibration sensation. CONCLUSIONS: South Asians with diabetes in the U.K. have about one-third the risk of foot ulcers of Europeans. The lower levels of PAD, neuropathy, insulin usage, and foot deformities of the Asians account for approximately half of this reduced foot ulcer risk. Lower neuropathy is the main contributor to the reduced African-Caribbean ulcer rate, particularly in men. The reasons for these ethnic differences warrant further investigation.

Age Factors↗
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↗
PubMedDate not supplied

Deep foot infections in patients with diabetes and foot ulcer: an entity with different characteristics, treatments, and prognosis.

We report findings in 223 consecutively included people with diabetes, foot ulcer and a deep foot infection treated by a multidisciplinary diabetic foot care team at the University Hospital in Lund, Sweden. The aim of the present study was to evaluate type and characteristics of deep foot infections and their relation to choice of treatment and outcome. Three different groups of deep foot infections were identified; osteomyelitis only (n = 112), deep soft tissue infection only (n = 46) and combined infections (osteomyelitis and deep soft tissue infection, n = 65). The various types of deep foot infections had different characteristics, treatment and prognosis. Patients with a deep soft tissue infection only or a combined infection had a significantly (p < 0.05) higher; (1) body temperature (38.0 and 38.0 vs. 37.3 degrees C), (2) erythrocyte sedimentation rate (75 and 80 vs. 56 mm/h) and (3) white blood count (11.0 and 12.0 vs. 8 x 10(9)) at diagnosis compared with those who had osteomyelitis only. Patients with a deep soft tissue infection only or a combined infection also had a significantly (p < 0.05) shorter time to surgery (2 and 4 vs. 10 days), higher mean number of surgical procedures (1.9 and 2.1 vs. 1.4 procedures) and higher percentage of patients had intravenous antibiotics (87 and 84 vs. 46%) compared with those who had osteomyelitis only. Amputation before healing was more common in patients with a combined infection (62%) compared with those who had osteomyelitis only (37%) or a deep soft tissue infection only (30%). The findings in the present study indicate that deep foot infections in patients with diabetes is a heterogeneous entity, in which the type of deep foot infection is related to choice of treatment strategy and to outcome. Therefore, these various types of infections has to be considered in future studies of deep foot infections in people with diabetes.

Aged↗
PubMedDate not supplied

Incorporating foot care education into diabetic foot screening.

Rehabilitation nurses care for patients with diabetes who have strokes, orthopedic surgery, and spinal cord injuries; therefore, they should be knowledgeable about foot screening technique and foot care education so that they can identify patients who are at risk for foot skin breakdown. The objectives of diabetic foot screening are to identify foot problems, determine a foot risk category and management category for patients, and to instruct patients with diabetes and their families in proper foot care. The screening technique is simple and can be used in clinic settings or at the bedside. Incorporating foot care education into the foot screening process increases or reinforces patients' knowledge of self-care. Such knowledge empowers patients to join with their healthcare teams to decrease the incidence of ulceration and amputation.

Diabetic Foot↗
PubMed2004

Impact of changing foot progression angle on foot pressure measurement in children with neuromuscular diseases.

To analyze the effect of lower-limb rotation on foot pressure distribution, 16 patients (23 feet) with neuromuscular diseases who received derotation osteotomy of lower limbs without concomitant foot-ankle procedures were included in this retrospective study. The cross-correlation analysis showed that the interval change of the foot progression angle was correlated with the interval change of the medial-lateral foot pressure impulse distribution. The externally rotated foot progression angle tends to introduce higher loading on the medial foot, and the internally rotated foot progression angle shifts the loading to lateral side of the foot. This study provides evidence that the rotational profile of the lower limb has a substantial impact on foot pressure distribution.

Adolescent↗
PubMed2004

Relationship between foot angles and hypermobility scores and assessment of foot types in hypermobile individuals.

This study proposed to assess foot types and radiological examination of feet of individuals with hypermobility syndrome in comparison to healthy matched controls for age, sex, and body mass index. The relationship between foot angles and hypermobility scores of subjects in both groups were also~assessed. Twenty individuals having joint hypermobility syndrome previously diagnosed according to Beighton and Bulbena scores were compared to 20 healthy subjects. Standing anteroposterior (AP) and lateral weigthbearing radiographs of feet of the individuals were taken. Foot angles and foot types were evaluated on the AP and lateral views. The mean +/- SD of Beighton and Bulbena scores were significantly higher in the hypermobile individuals (p <.001) than in controls. In both groups, Egyptian and square types of feet were mostly encountered (p >.05). Bilateral calcaneal pitch (CP) angles (p <.001), bilateral talometatarsal (TM) angles (p <.01), and right apex angles (p <.05) were significantly low in hypermobile individuals, whereas first metatarsophalangeal (MTP) angles were significantly high (right foot, p <.01; left foot, p <.05) as compared to the control group. Hypermobility scores correlated negatively with bilateral CP and TM angles and positively with bilateral first MTP angles. No correlation was found for the other~angles. These finding suggest that foot angles (especially CP, TM and first MTP angles) are in relation with severity of hypermobility. There was no difference between foot types in the hypermobile individuals and healthy controls. These angles may be useful for clinically monitoring the foot health in the hypermobile individuals.

Female↗
PubMed1997

Foot structure and foot protein in the cross striated muscle of a pecten.

The foot-like structure of pecten (mollusk) cross striated muscle cells was studied from structural and biochemical standpoints, and compared with foot structures of vertebrate skeletal muscle cells. In vertebrate muscles, foot structures have been observed at the interspace between T-tubules and sarcoplasmic reticula (SR). In pecten muscles, T-tubules were not observed, but SR were found situated in the outer portions of the cell contacting the cell membrane, and foot-like structures were recognized at the interspace between the SR and cell membrane. We could isolate the SR fraction from these muscles in which vesicles of SR/cell membranes were included. In the SR fraction, foot-like structures were observed ultrastructurally by thin sectioning. The size and shape of the foot-like structure, whether observed in intact cells or SR fractions, appear smaller than foot structures of vertebrates. However, when calculated by SDS-PAGE, the molecular weight of the structure is similar to that of vertebrates. These findings are discussed and compared to characteristics of foot structures and foot proteins of vertebrate skeletal muscles reported in previous studies.

Animals↗
PubMed1992

The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study.

Foot ulceration results in substantial morbidity amongst diabetic patients. We have studied prospectively the relationship between high foot pressures and foot ulceration using an optical pedobarograph. A series of 86 diabetic patients, mean age 53.3 (range 17-77) years, mean duration of diabetes 17.1 (range 1-36) years, were followed-up for a mean period of 30 (range 15-34) months. Clinical neuropathy was present in 58 (67%) patients at baseline examination. Mean peak foot pressure was higher at the follow-up compared to baseline (13.5 kg.cm-2 +/- 7.1 SD vs 11.2 +/- 5.4, p less than 0.001) with abnormally high foot pressures (greater than 12.3) being present in 55 patients at follow-up and 43 at the baseline visit (p = NS). Plantar foot ulcers developed in 21 feet of 15 patients (17%), all of whom had abnormally high pressures at baseline; neuropathy was present in 14 patients at baseline. Non-plantar ulcers occurred in 8 (9%) patients. Thus, plantar ulceration occurred in 35% of diabetic patients with high foot pressures but in none of those with normal pressures. We have shown for the first time in a prospective study that high plantar foot pressures in diabetic patients are strongly predictive of subsequent plantar ulceration, especially in the presence of neuropathy.

Diabetes Mellitus, Type 1↗
PubMed2005

Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society.

Foot infection is the most common reason for hospital admission of diabetic patients in the United States. Foot ulceration leads to deep infection, sepsis, and lower extremity amputation. Prophylactic foot care has been shown to decrease patient morbidity, decrease the utilization of expensive resources, and decrease the risk for amputation and premature death. The Diabetes Committee of the American Orthopaedic Foot and Ankle Society has developed guidelines for the implementation of this type of prophylactic foot care. The screening examination includes evaluation for peripheral neuropathy, skin integrity, ulcers or wounds, deformity, vascular insufficiency, and footwear. Foot-specific patient education includes instruction on self-examination and foot care practices. Individualized foot-specific patient education is indicated for patients with peripheral neuropathy. Treatment is outlined based on risk level, which is determined by the presence of peripheral neuropathy, deformity, and ulcer history. Treatment combines patient education, orthoses, footwear, and a timetable for ongoing skin and nail care. Ulcer care includes paring of calluses, debridement of infected or nonviable tissue, dressings, and off-loading. Specialty assistance may be required from a vascular surgeon, orthopaedic surgeon, podiatrist, endocrinologist/diabetologist, infectious disease consultant, radiologist, and pedorthist.

Diabetic Foot↗
PubMedDate not supplied

The Bristol Foot Score: developing a patient-based foot-health measure.

We sought to develop a patient-centered foot-health assessment tool by conducting in-depth interviews, focus groups, and surveys of relevant patient groups. A total of 400 hospital- and community-based podiatric patients took part in the development of the Bristol Foot Score, which was refined from a 41-item self-administered questionnaire to one containing 15 items. Podiatric patients easily understood the final questionnaire, and rates of completion were excellent. Overall reliability was high (Cronbach alpha = .9036), and application of the Bland and Altman technique suggested that the foot score produced stable measurements over time. Statistically significant differences were detected in scores before and after toenail surgery, indicating that the Bristol Foot Score is sensitive to change. A poor level of concordance was found between the Bristol Foot Score and a Chiropody Assessment Criteria Score routinely used by podiatrists to assess the need for podiatric care. The Bristol Foot Score reflects patients' perceptions of their own foot health, providing a useful additional tool for evaluating the efficacy of interventions and describing foot health within populations.

Adolescent↗
PubMed1980

Functional articulation of some hominoid foot bones: implications for the Olduvai (hominid 8) foot.

Previous observations on twelve fossil foot bones (Olduvai 8: Day and Napier, '64) together with multivariate morphometric studies of one of them, the talus (Day and Wood, '68) suggested human-like bipedality for this foot. Subsequent studies showed the conclusions on the talus to be wrong: The fossil talus, as defined by eight measures, does not resemble that of man but is reminiscent of those of creatures known (extant--orangutans) or believed (extinct--some fossil apes and monkeys) to be arboreal in habitus (Oxnard '72; Lisowski, et al., '74, '76). A reassessment of the entire Olduvai 8 foot is therefore necessary to answer the problem posed by a foot that has a non-human talus with, apparently, a human arched pattern of the remaining tarsal and metatarsal bones. The dry bones of a series of feet of extant hominoids have been rearticulated and are found to be close to the actual relationships presented by dissected specimens in which ligaments, articular cartilages and soft tissues are present. Similar rearticulation applied to casts of the individual Olduvai foot bones produces a structure that is not arched in the same manner as the human foot; it displays features that ally it more closely with the feet of various apes. Sections of casts of the already rearticulated Olduvai foot (from both the Wenner Gren Foundation and the Kenya National Museums) show that the human-like appearance of the original rearticulation is due to a series of incorrect osteological alignments. Although casts do not permit study of surface features, the dimensions of the casts are sufficiently accurate to permit rearticulation in this manner. It is thus clear, a) that the Olduvai foot is not adated for bipedality in the manner of man, and b) that it displays features in which it resembles the feet of arboreal creatures. Such anatomical characters as relate to bipedality in the fossil suggest usage as in an arboreal species that also walks bipedally with flattened arches (like a chimpanzee or gorilla) rather than with the high arches of man.

Adult↗
PubMed1998

Assessment of foot-to-foot bioelectrical impedance analysis for the prediction of total body water.

OBJECTIVE: To investigate the accuracy of foot-to-foot impedance methodology for the prediction of total body water and whether leg length rather than stature should be used in the prediction of total body water. DESIGN: Cross-sectional study using volunteers from the community. SETTING: University laboratory. SUBJECTS: 57 subjects (29 male; 28 female) aged 19-56 y. INTERVENTIONS: Total body water was measured using a deuterium oxide dilution technique. Total body water was also predicted using foot-to-foot impedance apparatus (Tanita Inc, Tokyo, Japan, Model TBF 305). RESULTS: Mean values for predicted and measured total body water differed by 0.71. However this bias was not constant across all individuals with a progressive underestimation of total body water by foot-to-foot impedance technology as the water content of the body increases. Also the use of leg length did not improve the accuracy of the prediction equation. CONCLUSIONS: At the population level predictions of total body water obtained from foot-to-foot impedance technology compare well with measured total body water. However the significant correlation between the difference between predicted and measured total body water and the absolute value for total body water is a concern especially if the technology is used for body composition assessment during a weight loss program.

Adult↗
PubMed2002

A three-dimensional shank-foot model to determine the foot motion during landings.

PURPOSE: The purposes of this study were a) to develop a model of the foot capable of describing the foot motion during dynamic movements and b) to study the influence of different mats on foot motion during landing in gymnastics. METHODS: Six female gymnasts (height: 1.63 +/- 0.04 m, weight: 58.21 +/- 3.46 kg) participated in this study. All six gymnasts carried out barefoot landings, falling from 80 and 115 cm onto three mats each with a different stiffness (hard, medium, and soft). Three synchronized digital high-speed video cameras (250 Hz) captured the motion of the left shank and foot. At the same time, the reaction forces between mat and foot at the forefoot and rearfoot were measured by two instrumented insoles (Paromed, 1000 Hz). The kinematics of the tibiotalar, talonavicular, and calcaneocuboid joints were examined. The lower leg and the foot were modeled by means of a multi-body system, comprising seven rigid bodies. For each joint, two joint coordinate systems attached on each of the connected segments were defined. RESULTS: The mat stiffness did not show any influence on the maximal reaction forces or on the kinematics of the tibiotalar joint. For the soft mat, higher maximal eversion angles at the talonavicular and the calcaneocuboid joints were measured. CONCLUSIONS: The relative motion between forefoot and rearfoot was influenced by changing mat stiffness. Therefore, the construction of the mat influenced the motion of the foot. The observation of only the tibiotalar joint is not enough when studying the influence of different mats on foot motion. The functional benefit of the mechanical advantages of a soft mat (higher energy absorption) includes a decrease in stability. The surface of the landing mat should, therefore, be reinforced by a stabilizing mechanism.

Adult↗
PubMed2000

Management of foot pain associated with accessory bones of the foot: two clinical case reports.

STUDY DESIGN: Case study. OBJECTIVES: To discuss the differential diagnosis, the nonsurgical and postoperative management of common accessory bones of the foot. BACKGROUND: Accessory bones of the foot that are formed during abnormal ossification are commonly found in asymptomatic feet. Two of the most common accessory bones are the accessory navicular and the os peroneum. Their painful presence must be considered in the differential diagnosis of any acute or chronic foot pain. The optimal treatment for the conservative and postoperative management of painful os peroneum and accessory navicular bones remains undefined. METHODS AND MEASURES: Therapeutic management of the fractured os peroneum included bracing, taping, and foot orthotics to allow healing of involved tissues, and stretching. The focus of the postoperative management of the accessory navicular was joint mobilization and progressive strengthening. Dependent variables included level of pain with provocation and alleviation tests of joint and soft tissue; girth and sensory tests of the foot and ankle; goniometric measures of foot and ankle; strength of ankle and hip muscles; functional tests; and patient's self-reported pain status. RESULTS: The patient with the fractured os peroneum was treated in 13 visits for 10 weeks. At discharge from physical therapy, the patient had the following outcomes relative to the noninvolved side: 100% return of normal sensation tested by light touch and vibration; pain decreased from 6/10 to 1/10; 100% reduction of swelling with ankle girth to normal; 100% range of motion of ankle and subtalar joints. Strength in plantar flexion and eversion remained 20% impaired (80% return to normal) secondary to pain. Upon discharge, he still reported mild pain when walking but was able to return to previous leisure activities. The second patient with the accessory navicular was treated in 18 visits over 9 weeks. Relative to the uninvolved side, she was discharged with the following: 70% return of range of motion in the foot and ankle, 100% of strength in hip and ankle, and 100% return of balance. She could squat and jump without pain and she returned to full premorbid activity level. CONCLUSIONS: Rehabilitative management of both cases addressed specific impairments and was successful in improving the patients' activity limitation. Clinicians should be aware that these accessory bones are possible sources of disability, secondary to foot pain.

Adult↗