Clinical Profile and Outcome of Diabetic Foot Ulcer in Teritary Care Hospital

Background: The goal of this study was to estimate the disease burden of diabetic foot ulcer (DFU) admissions in a tertiary care hospital in a developing country in terms of clinical profile and outcome. Method: In this descriptive study, the data were collected from the medical record of diabetic patients with foot ulcer who were treated in Saveetha medical college and hospital between the period of February to November 2020. The demographic characteristic, type of foot lesion, etiology, isolated microorganism, treatment, and outcome were reviewed. Results: There were 180 admissions with diabetic foot problems involving 100 patients. All of the patients had type 2 diabetes, and there was no gender bias. The average age was 50, and diabetes control was poor. The majority of patients had no knowledge what had caused their symptoms. In 56 % of cases, ulcers were neuropathic, 25% were neuro ischemic, and a smaller fraction were pure ischemia. More than 70% of ulcers were Wagner grade 3 or higher, with infection occurring in nearly every patient. Gram-negative bacteria were the most prevalent isolates from culture. A total of 30 lower extremity amputations (LEAs) were performed at various levels of the foot. Conclusion: Diabetic foot problems are a source of morbidity, a reason for LEA surgery, and a cause of death in people who have diabetes mellitus.

Risk Factors, Clinical Features, and Radiographic Abnormalities of Feet in Diabetic Patients

BACKGROUND Foot problems are a leading cause of hospitalization for patients having diabetes mellitus all over the world. Foot ulcers in diabetes precede 85 % of nontraumatic lower-extremity amputations. Fifteen percent develop foot ulcers during their lifetime. Individuals who develop foot ulcers have a decreased health-related quality of life and consume a lot of healthcare resources. Foot abnormalities is a frequently missed diagnosis and a focus in this area of medical education has never been optimal despite its frequency of presentation. In this study, we wanted to determine clinical and radiographic foot abnormalities in diabetic patients. METHODS A cross-sectional study was carried out on 180 type 2 diabetic patients diagnosed as per ADA definition of diabetes, they were categorized into three groups, the first consisted of 60 diabetic patients without neuropathy or foot ulcers, the second had 60 diabetic patients with neuropathy and the third had 60 diabetic patients with both neuropathy and foot ulcer. Based on the clinical examination of the foot and foot X-ray oblique and lateral view of the affected feet along with other relevant investigations were obtained and analysed using descriptive and inferential statistical analysis. RESULTS We observed that poor glycaemic control and duration of diabetes were important risk factors for foot complications in diabetic patients which were statistically significant. Among patients with only diabetes, 3.3 % had HbA1c less than 6, 35 % had HbA1c between 6 - 9 and 61.7 % with HbA1c of more than 9. Among the patients with diabetes and neuropathy, 1.7 % of people had Hba1c of less than 6, 20 % with Hba1c between 6 - 9 and 78.3 % with Hba1c of more than 9. In patients who had diabetes and neuropathy with foot ulcers, 6.7 % had HbA1c of less than 6, among the same cohort 8.3 % had HbA1c between 6 - 9 and 85 % had HbA1c above 9. The prevalence of various radiological abnormalities of the foot was more common in diabetic patients with both neuropathy and foot ulceration (group lll) (83.3 %). The most common abnormality as observed from our study was Osteopenia with osteoporotic changes seen in 36.7 % of Group III patients VS 16.7 % of Group II (patients with diabetes and neuropathy ) and only in 10 % of Group I patients (patients with diabetes without any complications). Vascular calcifications were observed in 26.7 % VS 16.7 % VS 6.7 % in Group III, Group II, Group I respectively. Periosteal reactions were also more common in Group III patients (6.7 %). Subluxation of 2nd, 3rd, 4th, and 5th metatarsals was observed only in 3.3 % of Group III patients. CONCLUSIONS Diabetic foot is one of the most devastating complications of diabetes. Preventing the diabetic foot should be the first priority. This can be achieved by identifying the high-risk individuals with the above said risk factors by proper clinical examination and use of foot X-ray. KEY WORDS Diabetic Foot, Foot Problems, Foot Infections.

Relationship between dynamic foot-ground contact area and balance impairments in adolescents with down syndrome

PURPOSE: Down Syndrome (DS) is characterized by intellectual disability, hypotonia, and joint laxity. Physical disability can be an additional problem and manifests as reduced lower limb muscle strength and impaired balance. The objectives of this study were to characterize DS dynamic foot-ground contact area and to study its relationship with balance impairment among adolescents with DS. METHODS: Twenty-eight children and adolescents with DS and 28 non-DS adolescents/children were matched for age and sex. The Oxford Ankle Foot Questionnaire (parents’ version) was used to measure disability related to ankle/foot problems in all subjects. A pressure-sensitive mat was used to assess the contact area and arch index. Also, a Biodex balance system was used for measuring postural stability. RESULTS: There were significant differences between both groups in all domains of the Oxford Ankle Foot Questionnaire, overall contact area, and arch index (p < 0.05). Overall postural stability index was significantly decreased in subjects with DS (p < 0.05). There was a nonsignificant correlation between contact area and postural stability (p > 0.05). CONCLUSION: Adolescents with DS exhibited larger mid-foot and forefoot contact areas with respect to non-DS matched children. Impairment of balance in adolescents with DS is a multifactorial problem not related to changes in the foot contact area.

Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review

(1) Background: ankle-foot orthosis (AFO) is the most commonly prescribed orthosis to patients with foot drop, and ankle and foot problems. In this study, we aimed to review the commonly used types of AFO and introduce the recent development of AFO. (2) Methods: narrative review. (3) Results: AFO prevents the foot from being dragged, provides a clearance between the foot and the ground in the swinging phase of gait, and maintains a stable posture by allowing heel contact with the ground during the stance phase. In clinical practice, the most commonly used AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO. In addition, for compensating the demerits of these conventional AFOs, new types of AFOs, including AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, were developed. (4) Conclusions: we think that our review can guide clinicians in selecting and prescribing the appropriate AFO for each patient in accordance with their specific physical conditions.

Role of a Nurse in Preventing the Diabetic Foot Storm

Diabetes mellitus is a common epidemic and metabolic condition worldwide, which needs serious concern to avoid major complication. Out of several complications diabetic foot ulcer is the impenetrable one. ‘Amit Jain’ from India has classified 6 categories of diabetic foot problems and describes the pathway towards the diabetic foot storm (Apoorva H C & Jain A K C, 2020). These categories and pathway is beneficial to construct preventive plan of action to detain diabetic foot storm. Diabetic foot storm encompasses different problem combined with diabetic foot condition. Nurses are playing vital role in every health care sector. They can save this storm with the knowledge of diabetic foot storm, pathway and different preventive strategies includes education, screening, awareness camping. Keywords: Diabetic foot, Storm, Strategies, Prevention, Epidemic.

An Introduction to Foot Planter Pressure Measurement System

Foot planter pressure is the area that is between the foot and the surface during daily life activities and other activities. It can help to solve the problems of such disease like gait, diabetes and foot ulceration. It also plays the main role in the patients who are at the risk of variety of foot problems. This paper is about to know the brief discussion on foot related problems. In this article we also discuss the types of foot planter pressure measurement and its future technology. Foot planter system is the system which is very helpful to the patients of foot problems. This system is not only for the patients of foot problems but also used in sports and our daily life. Future applications of the planter pressure to improve in design and more comfortable. High plantar pressures have been shown to be a key risk factor for foot ulceration in people with diabetes. Patients are generally prescribed insoles designed to reduce pressure. New technologies like plantar pressure measurement devices and 3D foot scanners have the potential to improve insole design. Still, it is not clear to what such technologies are currently using by physicians. After that, there has been previous research designed to understand how best to use technology to improve insole design for patients with diabetes.

Impact of quality of life related to foot problems: a case–control study

Foot problems are highly prevalent conditions, being a frequent reason for medical and podiatric consultation. The aim of this study was to compare the differences of quality of life (QoL) related to foot health in people with and without the presence of foot problems. A case–control study was carried out in an outpatient centre, where a clinician recorded data related to sociodemographic and clinical characteristics. In addition, self-reported data on foot health-related quality of life were recorded using the Spanish version of the Foot Health Status Questionnaire. The sample consisted of 498 participants (249 cases and 249 controls), with a median age of 30 years and an interquartile range of 23 years. The differences between the groups were statistically significant for gender, age, footwear, general health, foot health, and physical activity. Cases showed lower scores for the domain of footwear, physical activity and vitality compared to controls. Foot pathologies have a negative impact on quality of life related to foot health, and the domains of footwear, general health and physical activity seem to be the factors that are associated with the presence of alterations and foot deformities.

The cause and frequency of PES Planus (Flat Foot) problems among young adults

Background: Pes planus, also known as flat foot, is one of the most commonly seen foot deformity. It is characterized by a very low or an absent arch, which is the main supportive structure of the foot. Pes planus deformity is associated with impaired foot movements and increased frequency of pain and discomfort. Aims and Objectives: The present study was carried out to estimate the prevalence of pes planus among young healthy individuals in South Indian population. Materials and Methods: This cross-sectional study was carried out among 500 individuals (168 males and 332 females) between the ages of 18 and 25 years. The feet of all subjects were visually inspected and footprint screening test was carried out. Results: The prevalence of pes planus among the study subjects was 29%. The highest prevalence and pattern of age wise distribution of pes planus was observed in 20 years (24%), followed by 18years (16%), 19& 21years (14%), 23years (13%), and 22,24&25 years (10%,6%,3% respectively). Conclusion: Regular screening and monitoring of this foot deformity would create awareness about foot problems and can guide care givers to provide suitable footwear for persons with pes planus. It is advisable to conduct early screening so as to reduce the flatfoot progression into the adulthood and would assist better in their physical activities.