Repeatability and Reliability of the Rheumatoid Arthritis Foot Disease Activity Index in Spanish Patients: A Transcultural Adaptation

Background: The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) questionnaire, based on five questions, is used to assess the severity of rheumatoid arthritis disease in the foot. Nowadays, RADAI-F5 has been validated in different languages; however a Spanish version was lacking. Therefore, the purpose of this research was to translate and validate the Spanish version (RADAI-F5-es). Methods: A cross-cultural translation of the RADAI-F5 questionnaire was performed from English to Spanish. To validate its use, 50 subjects with rheumatoid arthritis who responded to the translated questionnaire two times in an interval of less than 3 months were selected in order to verify the psychometric properties. Results: Excellent agreement between the two versions according to the Cronbach’s α was shown. Five domains with regards to arthritis activity in foot joint tenderness and swelling, foot arthritis pain, general foot health and joint stiffness were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for joint stiffness on awakening and foot arthritis pain domains. There were no significant differences among any domains (p > 0.05). There were no statistically significant differences (p = 0.000) for the mean ± standard deviations (SD) between pre- and post-tests (98.09 ± 15.42) [93.75–102.43] and 97.96 ± 13.88 [94.5–101.86] points, respectively). Bland–Altman plots or clinically pertinent variations were not statistically significantly different. Conclusions: The RADAI-F5-es is considered a valid and strong tool with adequate repeatability in the Spanish community.

Foot shape and radiographs of free-ranging Nubian giraffe in Uganda

Foot health in zoo giraffe has been a topic of recent research, although little is known about the foot health of free-ranging giraffe. This study describes the foot shape and radiographic pathological changes in 27 young adult Nubian giraffe (Giraffa camelopardalis camelopardalis) from a translocation in Uganda (August 2017). Giraffe feet were observed to have a concave sole, the hoof wall was longest by the toe tip, and the weight-bearing surface of the foot was primarily along the periphery of the foot including hoof wall, parts of the heel, and the edge of the sole. Radiographs showed that pedal osteitis and sesamoid bone cysts were relatively uncommon (3/24 giraffe with osteitis, 1/24 giraffe with sesamoid cysts), and that no giraffe in the study had P3 joint osteoarthritis, P3 rotation, or P3 fractures. Radiographs consistently demonstrated a positive palmar/plantar angle with the sole of the hoof thicker at the heel than by the toe tip, with the non weight-bearing palmar/plantar angle measuring 1.6°- 4.3°. This is the first systematic review of foot shape and radiographs in free-ranging giraffe and demonstrates a low prevalence of foot pathologies. This study suggests qualitative differences in foot shape, foot health, radiographic anatomy, and foot pathologies when comparing free-ranging and zoo giraffe. Further research is needed to identify why these differences occur and whether husbandry modifications could help improve zoo giraffe foot health and prevent associated lameness.

Observations of Cattle Hoof Health and Performance Over Time in Deep Bedded Monoslope Buildings

The use of deep bedded, monoslope, cattle barns without complete manure removal can have negative implications regarding foot health and subsequent performance of feedlot cattle over time.  More frequent manure removal may be part of the solution.

Establishing the national top 10 priority research questions to improve diabetes-related foot health and disease: a Delphi study of Australian stakeholders

IntroductionDiabetes-related foot disease is a large cause of the global disease burden yet receives very little research funding to address this large burden. To help address this gap, it is recommended to first identify the consensus priority research questions of relevant stakeholders, yet this has not been performed for diabetes-related foot disease. The aim of this study was to determine the national top 10 priority research questions for diabetes-related foot health and disease from relevant Australian stakeholders.Research design and methodsA modified three-round Delphi online survey design was used to seek opinions from relevant Australian stakeholders including those with diabetes or diabetes-related foot disease or their carers (consumers), health professionals, researchers and industry. Participants were recruited via multiple public invitations and invited to propose three research questions of most importance to them (Round 1), prioritize their 10 most important questions from all proposed questions (Round 2), and then rank questions in order of importance (Round 3).ResultsAfter Round 1, a total of 226 unique questions were proposed by 210 participants (including 121 health professionals and 72 consumers). Of those participants, 95 completed Round 2 and 69 completed Round 3. The top 10 priority research questions covered a range of topics, including health economics, peripheral neuropathy, education, infection, technology, exercise, and nutrition. Consumers prioritized peripheral neuropathy and prevention-related questions. Health professionals prioritized management-related questions including Australia’s First Peoples foot health, health economics and infection questions.ConclusionsThese priority research questions should guide future national research agendas, funding and projects to improve diabetes-related foot disease burdens in Australia and globally. Future research should focus on consumer priority research questions to improve the burden of diabetes-related foot disease on patients and nations. Further research should also investigate reasons for different priorities between consumers and health professionals.

Reporting of Research Ethics in Studies Focusing on Foot Health in Patients with Rheumatoid Arthritis – A Systematic Review

Research ethics is a fundamental part of the entire research. Patients with rheumatoid arthritis are sensitive group of research participants because their long-term health problems cause significant changes in their foot health. In foot health research, data are usually collected through a clinical assessment of the foot or questionnaires. However, there is limited evidence of the reported research ethics of empirical studies on foot health in patients with rheumatoid arthritis. Therefore this review aimed to analyze the reported research ethics of peer-reviewed empirical studies focusing on foot health in patients with rheumatoid arthritis as research participants. This systematic review used the Medline/PubMed, CINAHL, and Embase databases. A total of 1,653 records were identified, and 32 articles were included in the final analysis. Reporting research ethics in studies of patients with rheumatoid arthritis is fragmented, focusing predominantly on ethical approval and informed consent and lacking a broader discussion about research ethics.

Diabetic Foot Amputations at Central and Provincial Hospital in Gauteng. A Signpost for Inadequate Foot Health Services at Primary Healthcare Level in South Africa

Background Diabetic foot amputations are the most devastating outcome for any diabetic patient and could be associated with failure to risk stratify the diabetic foot and create individualised treatment plans to lower risk at the primary healthcare level (PHC). In South Africa (RSA), PHC clinics are the first entry point to the public healthcare system. Failure to correctly identify, risk categorise, and refer diabetic foot complications may lead to poor clinical outcomes for diabetic patients. There is a need to highlight poor clinical outcomes and link them to limited access to foot health services at the PHC level. This approach may help drive the strategic allocation and deployment of limited podiatry force in RSA. This study looks at the incidence of diabetic-related amputations at central and tertiary hospitals in Gauteng to argue the case of the needed foot health services at the PHC level. Methods A cross-sectional retrospective study that reviewed theatre records. We reviewed records of all diabetic patients who had diabetic-related amputations between January 2017 and June 2019. Results There were 1862 diabetic-related amputations; however, only 1565 accurately recorded and met the inclusion criteria for the study. The first amputation was a major amputation in 73% of the cases, and an infected foot ulcer was a primary amputation cause in 75% of patients. Males had the most amputations, 62%. The majority, 71% of amputations, were in patients younger than 65 years. Nearly all patients (98%) came from a poor socio-economic background and are state-dependent; they earned ZAR 0.00- 70 000.00 or USD (0.00- 4754.41) per annum. Conclusion Amputations are a sign of poor clinical outcomes for diabetic patients and imply inadequate care of diabetic foot complications across the continuum of care, particularly at the PHC level in RSA. Due to the hierarchal nature of healthcare delivery in RSA, all patients in this study would have presented at a PHC facility to manage their diabetes and other chronic comorbidities. The findings show that most first amputations recorded in this study were major amputations. This finding is a significant signpost of the potential delay in recognising, treating and timely referral of diabetic-related foot complications. Arguably, a lack of access to structured foot health services at PHC levels impedes early identification of foot complication identification and appropriate referral resulting in the amputation in some of the patients.

Optimising foot health in dairy cattle

This chapter examines optimising foot health in dairy cattle. The chapter begins by reviewing the importance of lameness then goes on to discuss claw horn disruption. It also reviews aetiopathogensis of white line bruising and lesions, which is then followed by a section on aetiopathogensis and control of digital dermatitis. A case study on an 800 cow Holstein herd with a sudden rise in sole ulcers and white line lesions is also included. The chapter concludes with an overview of the emerging diseases in dairy cattle.

Children should be seen and also heard: an explorative qualitative study into the influences on children’s choice of footwear, their perception of comfort and the language they use to describe footwear experiences

Background Footwear has an essential role including protection of the feet, overall performance, foot health and potentially, supporting normal development of the foot. In addition to these physical aspects which may influence choice of footwear design, there are psychological influences on what a person chooses to wear. The concept of footwear ‘comfort’ spans physical and psychological perceptions of comfort in adults. However, there is little understanding of what influences children’s footwear choices, how children perceive footwear comfort, or the language used to describe footwear experiences. Therefore, this study aimed to explore these three parameters as the first step to informing the development of a scale to measure footwear comfort in children. Methods A pragmatic qualitative design with thematic analysis as an analytical approach was implemented. Passive observation and short interviews were carried out with 23 children (aged 1–12 years) at a footwear manufactures headquarters and store. Prompts included shoes being tried on and field-notes were taken relating to verbal and non-verbal communication. Field notes were coded then themes were identified, reviewed and named. Results Overall, the children equated comfort to softness. However, influences on footwear choice were multidimensional including aesthetics, psychosocial influences, identified ‘comfort’ and ‘discomfort’ areas, practical issues and predictive concerns; all interacting with the age of the child. Conclusions For children, footwear comfort is a complex phenomenon having physical, cognitive, social and emotional developmental components. This can be seen in how the children perceive the ‘feel’ of the shoe and how the shoe is assessed in the context of how the shoe meets the child’s physical and psychosocial developmental needs. In younger children footwear preference is related to idiosyncratic tastes in aesthetics, physical ability and comfort. As children age, societal influences begin to expand the social function of footwear denoting group membership, to include themes that transcend the functional and social function of footwear. The knowledge from this study can inform the development of age group specific tools to evaluate comfort.