Journal of Foot and Ankle Research最新文献

Aim: To prospectively evaluate the association of various markers of sarcopenia and frailty with clinical outcomes in diabetes-related foot disease (DRFD), namely wound healing, amputation-free survival, and death over 3 years.

Methods: This was an observational study of patients with DRFD at a quaternary multidisciplinary diabetic foot service. Initial assessment includes classification of DRFDs using WIfI classification, assessment of frailty using the FRAIL scale, and measurement of handgrip strength (HGS) using a dynamometer. Muscle mass was ascertained by measuring the psoas muscle area at the level of L3 vertebrae on computed tomography. Patients were followed up for 3 years and primary outcomes were wound healing, amputation-free survival, and death.

Results: One hundred patients with a median age of 71 were included in the analysis. The majority of the patients were male (75%). Forty-seven percent of patients were considered as frail, with 37 patients recorded to have low HGS. Patients with high HGS had significantly higher odds of wound healing by 3.83 times when compared to those with low HGS (odds ratio = 3.83. 95% CI 1.35-10.92). Patients with low psoas muscle index (PMI) and low HGS were observed to have a higher risk of death based on the following hazard ratios: HGS (high vs. low), HR = 0.46, 95% CI: 0.22-0.997; PMI (low vs. high), HR = 2.15, 95% CI: 1.17-3.96.

Conclusion: There was a significant prevalence of frailty and reduced HGS among our patients with DRFD. Low HGS was associated with poor wound healing and increased mortality in patients with DRFD. Additionally, low muscle mass was associated with increased mortality in this population. This research highlights the need for more precise tests and future studies of the links between sarcopenia, frailty, and outcomes in DRFD.

Introduction: Diabetes-related foot ulcer (DFU) is the leading cause for lower extremity amputations (LEAs) in western countries, and may cause social isolation, depression, and death. However, people with DFU are not offered the same prioritized care as cancer patients, despite comparable mortality rates. We therefore decided to create a clinical pathway for patients with DFU. The purpose of this study is to evaluate the efficacy of implementing a new clinical pathway on rates of LEA, length of hospital stays, and cost reduction.

Methods: On January 1, 2019, a new clinical pathway ensured that all patients with a DFU were evaluated in a designated clinic run by a foot and ankle orthopedic surgeon in collaboration with the vascular surgeons, supported by a specialized wound nurse and a certified prosthetist/orthotist (CPO). We designed an algorithm for the first consultation to identify patients in need for further investigation by other specialties such as endocrinology, infectious diseases, cardiology, or vascular surgery. All patients underwent a surgical wound debridement of DFU. Negative pressure wound therapy (NPWT) was not applied. After surgery, the dressings were changed daily on the ward, until the wound was deemed viable and clean. The patients were followed for two years and compared to a historic cohort of patients with DFU admitted to the institution in 2017.

Results: The number of major amputations was reduced from 65% (13/20) to 7.4% (2/27) (p < 0.001) after the introduction of the clinical pathway. Both the mean number of surgical revisions (5.5 vs. 1.2) and the median length of stay (46 vs. 9 days) were statistically significantly reduced. The median cost per patient was reduced by 76% (from €538 000 to €129 000, p < 0.001).

Conclusion: The clinical pathway for managing DFUs resulted in a reduction in major amputations and shorter hospital stays. Discontinuing NPWT after surgical debridement did not adversely affect clinical outcomes. The new pathway also contributed to lower healthcare costs.

Introduction: Psychological factors are linked to pain and function in various musculoskeletal conditions, but their impact on hallux valgus is unclear. Health-related quality of life declines with increasing severity of hallux valgus, affecting not only foot pain and physical function, but also general health, vitality and mental health. Previous studies have reported inconsistent associations between psychological factors, such as anxiety and depression, and surgical outcomes, which might relate to variability in measurement approaches. Understanding the associations between psychological factors, including anxiety, depression, pain catastrophizing and kinesiophobia, and hallux valgus-related pain and function may inform more holistic pre-operative care. Therefore, we aimed to assess these associations in adults with hallux valgus pre-surgery.

Methods: A pre-operative cross-sectional study was conducted with 41 adults scheduled for hallux valgus surgery. Participants completed questionnaires measuring continuous psychological variables: depression, anxiety and stress (Depression Anxiety Stress Scale-21, a tool for general psychological distress), kinesiophobia (Tampa Scale for Kinesiophobia, which assesses fear of movement associated with pain) and pain catastrophizing (Pain Catastrophizing Scale, a tool used to evaluate maladaptive pain-coping strategies). Continuous outcomes were evaluated using the Manchester-Oxford Foot Questionnaire for foot function, pain and social interaction. Multiple linear regressions explored the associations between these psychological factors and the outcomes.

Results: When all exposure variables were considered simultaneously, pain catastrophizing emerged as a significant predictor of foot pain and foot function. A one-unit increase in the pain catastrophizing score was associated with a 1.41-point increase in foot pain (β = 1.41, 95% confidence intervals (CIs) 0.73-2.09 and p < 0.001) and a 1.83-point increase in worse foot function (β = 1.83, 95% CI 1.12-2.54 and p < 0.001).

Conclusion: Assessing pain catastrophising pre-operatively is recommended for individuals with hallux valgus, although more structured education may be needed to support health professionals in assessing psychological factors. Future research should evaluate the longitudinal impact of pain catastrophizing on post-operative outcomes and explore other contributing factors, such as comorbidities, lifestyle variables and sex differences, to refine screening and treatment strategies.

Introduction: Adult acquired flatfoot deformity (AAFD) is a disabling condition that may require complex surgical treatment. Little is known about the incidence of AAFD in the general population and specifically of AAFD requiring specialist care. We aimed to describe the incidence of AAFD referred to specialist care in the Swedish general population.

Methods: We conducted a nation-wide epidemiological register study to estimate the incidence of referred AAFD in the general population. We retrieved data from the Swedish National Patient Register. All individuals aged 16 years or older, with a first-time diagnosis of AAFD (ICD-10 code M214) between 2007 and 2018 were identified. Total incidences, change over time, and gender-specific and age-specific incidences per 100,000 person-years were calculated using population size data from Statistics Sweden. Incidences were compared using the Poisson test.

Results: The incidence rate of referred AAFD in the general population was 23.0 (95% CI 22.7-23.3) per 100,000 person-years. The incidence rate in women was 30.4 (95% CI 29.9-30.8) and in men was 15.4 (95% CI 15.1-15.8). The highest incidence rates were found in the age Group 61-75 years. The incidence rates varied significantly across the 21 regions in Sweden. The age-standardized and sex-standardized incidence rates ranged from 8.3 (95% CI 7.2-9.4) to 69.1 (95% CI 62.4-75.8).

Conclusion: AAFD requiring referral to specialist care is common in the general population. Women had nearly twice the incidence of AAFD compared to men. Large unexplained regional variations in the incidence rates exist.

Background: The patient-specific shape of custom accommodative insoles for individuals with diabetes provides full foot-to-insole contact, offloading areas with high plantar pressures and reducing ulceration risk. To design the insole surface, plantar surface shape is captured, traditionally with a foam crush box impression or more recently with 3D scans of the foot. Beyond discrete measurements of the foot, the overall plantar surface shapes obtained from these different methods have yet to be compared, however, differences in the shapes captured by these methods may affect the insole's surface geometry design and subsequent performance.

Methods: Plantar surface shapes of 12 individuals with diabetes were captured using a foam crush box, flatbed 3D foot scanner, and handheld 3D scanner. Foot length, width, arch height, and arch volume were measured from each shape-capture method and compared. Mesh-to-mesh distances between the foam crush box mesh and the direct scanning method meshes for each subject were calculated.

Results: Foot length and width measured from the foam crush box scan were greater than the foot length measured from the flatbed scan and handheld scan. The flatbed scan also measured a length and width greater than the handheld scan. Arch heights and volumes from the flatbed scan were less than the heights calculated from the foam crush box and handheld scan. Mesh-to-mesh distances for the flatbed scan and areas of the foot not in contact with the scanner were inferior to the corresponding areas in the foam crush box impression. For the handheld scan, the lateral hindfoot and midfoot were superior, and the medial forefoot was inferior to the foam crush box impression.

Conclusions: Different clinical methods used to capture foot shapes for the design of accommodative insoles may result in different plantar surface shape outputs and therefore impact custom accommodative insole design.

Background: Midfoot pain is common but poorly understood, with radiographs often indicating no anomalies. This study aimed to describe bone, joint and soft tissue changes and to explore associations between MRI-detected abnormalities and clinical symptoms (pain and disability) in a group of adults with midfoot pain, but who were radiographically negative for osteoarthritis.

Methods: Community-based participants with midfoot pain underwent an MRI scan of one foot and scored semi-quantitatively using the Foot OsteoArthritis MRI Score (FOAMRIS). Foot pain and disability were recorded using visual analog scales (VAS) and the Modified-Manchester Foot Pain Disability Index (MMFPDI). Associations were assessed for continuous data using Spearman's Rho, and for categorical data, a Wilcoxon signed rank test. Linear regression was used to explore the association between participant-reported measures and MRI abnormalities, adjusted for age, sex and BMI.

Results: Sixty-one participants (70% female, mean age 48.5 years, median BMI 28.6 kg/m²) were included. Median VAS pain was 31/100 mm (IQR 21-47) and median disability was 30/48 (IQR 26-36). There was a moderate association between midfoot pain severity and the number of joints exhibiting joint space narrowing; adjusted results suggested 31% (95% confidence interval 3%-68%) worse VAS pain with each additional affected joint. Greater numbers of joints with cysts were associated with worse VAS pain [14% (0%-31%)] and disability [1.1 units (0-2.2)]. Effusion/synovitis was associated with MMFPDI pain. No other MRI abnormalities were associated with sex, body mass and foot pain/disability measures. Bone marrow lesions, joint space narrowing, cysts and osteophytes occurred more frequently with age. MRI abnormalities were common, particularly in the talo-navicular joint, first and second cuneo-metatarsal joints. Those with dorsal foot pain had more multi-joint involvement, bone marrow lesions, joint space narrowing and cysts and for those with pain on midfoot movement, bone marrow lesions and cysts were reported.

Conclusions: In people with midfoot pain, MRI-detected features of osteoarthritis and soft-tissue abnormalities were found, clustered in the medial and intermediate cuneiform joints. These features were more common with age but not associated with pain or disability measures. Younger people with dorsal midfoot pain exhibited early signs of bone and joint features of osteoarthritis and we recommend further imaging studies to determine the clinical and diagnostic significance.

Background: Dissection and examination of prosected cadavers is a tool for teaching anatomy. However, this experience can provoke anxiety and stress among students. This study aims to understand the attitudes, reactions, fears, and anxiety states of podiatry students before their first dissection in addition to evaluate its usefulness as an educational tool for academic training in anatomy.

Methods: A cross-sectional study was carried out before and after the dissection room visit of first-year podiatry students. They were given several questionnaires: State-Trait Anxiety Inventory questionnaires (STAI-state anxiety and STAI-trait anxiety) and two anonymous questionnaires.

Results: Levels of total emotional anxiety (STAI-state anxiety) decreased significantly (p < 0.05) from 16.9 points before practice to 10.9 points after practice. In terms of gender, significant differences (p < 0.05) were observed in anxiety levels before and after practice. However, female students had significantly (p < 0.05) higher pre-practice levels of STAI-state anxiety than male students.

Conclusions: Although 100% of students (3.98 ± 0.149, over 4) expressed satisfaction with the practical's dissection and considered that these contributed significantly to the consolidation of their anatomical knowledge, the experience generated emotional responses that need to be addressed. Higher levels of anxiety were observed among female students, highlighting the need to implement effective coping mechanisms to mitigate emotional reactions, with special emphasis on this population.

Atrial fibrillation (AF) is a global health crisis affecting 33.5 million people, with costs projected to reach £75 billion by 2035. A significant concern is that 43-48% of cases are asymptomatic, increasing the risk of stroke and heart failure. While general population screening lacks strong support, targeted screening shows promise in reducing stroke occurrence and healthcare costs. Podiatrists, who frequently treat adults of advancing age, are uniquely positioned to detect AF in high-risk, asymptomatic individuals. This commentary advocates for opportunistic AF screening by podiatrists and other healthcare professionals, offering guidance for implementation. Early detection through defined referral pathways is crucial for timely diagnosis and management, potentially reducing AF-related strokes that can lead to early mortality. Further high-quality podiatry-led studies are recommended to build on this commentary paper.

Background: This study investigated the effect of various offloading devices commonly used for the management of diabetic foot ulcerations on peak plantar pressure and pressure-time integral of the contralateral limb.

Methods: A quantitative, randomised and within-subject repeated measures study was conducted in an outpatient gait laboratory. Outpatients with unilateral diabetic foot ulcers and adequate perfusion to the lower limb without an intrinsic limb-length discrepancy who were able to walk were recruited for the study. They were also required to understand English. An in-shoe pressure sensor was placed in the participants' everyday shoes between their feet and insoles. Participants were asked to walk at their own speed and cadences with three stances recorded. Their peak and mean plantar pressures were recorded. This was repeated with four different offloading conditions: Darco APB™ All Purpose Boot, Darco APB™ All Purpose Boot with wool felt adhered to the bottom of the foot, DH Offloading Walker® and DH Offloading Walker® with Even-Up™ on the contralateral foot.

Results: The total sample comprised 22 adults (3 females and 19 males) aged between 34 and 78 years old (mean age, 57.6 ± 9.9 years). The results indicated that none of the regions of the foot showed a statistically significant difference in peak plantar pressure and pressure-time integral between the control condition and other offloading modalities, or between modalities.

Conclusion: The use of offloading modalities for diabetic foot ulcers does not significantly affect peak plantar pressure or pressure-time integral measures on the contralateral limb. However, this should be considered with caution, as this population will possess the same risk factors in both the affected and the contralateral foot.

Background: Health inequalities are a well-known and widespread phenomenon throughout health care settings. In particular, people of color experience higher rates of delayed and/or misdiagnosis contributing to poorer outcomes and an increased mortality risk. Research suggests that health care professionals find it more difficult to correctly diagnose dermatological conditions in the non-White patient demographic. Although podiatrists routinely examine and assess skin lesions, there is a paucity of research exploring their accuracy or confidence in recognizing skin pathologies. This study aims to investigate podiatry student's ability, confidence, approaches, and perceptions in diagnosing dermatology pathologies in different skin tones. A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

Methods: A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.