Search Results
In this study of people with diabetes mellitus and peripheral neuropathy, it was found that the feet of patients with a history of hallux ulceration were more pronated and less able to complete a single-leg heel rise compared with the feet of patients with a history of ulceration elsewhere on the foot. The range of active first metatarsophalangeal joint dorsiflexion was found to be significantly lower in the affected foot. Ankle dorsiflexion, subtalar joint range of motion, and angle of gait differed from normal values but were similar to those found in other studies involving diabetic subjects and were not important factors in the occurrence of hallux ulceration. These data indicate that a more pronated foot type is associated with hallux ulceration in diabetic feet. Further studies are required to evaluate the efficacy of footwear and orthoses in altering foot posture to manage hallux ulceration. (J Am Podiatr Med Assoc 96(3): 189–197, 2006)
Hiking with Diabetes
Risks and Benefits
Background:
Exercise is highly beneficial for persons with diabetes. Similar to many other patients, those with diabetes may be reluctant to exercise given a lack of motivation and proper instruction regarding an exercise prescription. In general, medical providers are poorly equipped to develop an exercise prescription and furnish motivation. Attempts to find activities that not only provide effective aerobic challenges but also are enjoyable to participate in are fraught with difficulty. Hiking as a potential option for a safe and enjoyable activity is discussed, including the possible downsides.
Methods:
Multiple publications were reviewed using key words.
Results:
A review of the literature uncovered limited publications or controlled trials that discussed the use of hiking per se as an activity for the management of diabetes. Newer studies reviewing weightbearing exercise and diabetic polyneuropathy and those discussing the advantages of trekking poles for balance and proprioception are cited in support of the recommendation for hiking as an activity for those with diabetes.
Conclusions:
Exercise has been shown to substantially benefit individuals with diabetes, but convincing patients with diabetes to exercise is daunting. Hiking, unlike other, more tedious exercise programs, may be an exercise option that persons with diabetes might find enjoyable. Hiking may encourage balance training and reduced ground reaction forces. These benefits may be augmented by trekking poles, which may likewise counter the concerns of the uneven surfaces that present challenges to the hiker with diabetes.
Background:
This study sought to identify the nature and extent of diabetes-related knowledge and self-care practices in people living with type 2 diabetes who attend primary-care clinics and to determine whether a correlation between the two exists.
Methods:
In a nonexperimental prospective study, the Diabetes Knowledge Questionnaire and the Summary of Diabetes Self-care Activities were used to assess knowledge and self-management in 50 patients.
Results:
The mean diabetes knowledge score was 14.40 out of a total of 24 and the mean self-care activities score was 2.89 out of a total of 7, indicating a deficit in a number of key areas in the management of diabetes. There was no statistically significant correlation between diabetes knowledge score and diabetes self-care activities (r = 0.190, P = 0.187). On analysis of the individual subscales, a significant relationship resulted between diabetes knowledge score and diet (r = 0.324, P = 0.022) but physical activity (r = 0.179, P = 0.214), blood sugar testing (r = 0.231, P = 0.107) and footcare (r = 0.189, P = 0.189) gave no significant results. On further analysis, education level was significantly correlated to diabetes knowledge score (r = 0.374, P = 0.007) and self-care activities score (r = 0.317, P = 0.025) while age was significantly correlated to diabetes knowledge score (P = 0.008) and self-care activities score (P = 0.035).
Conclusions:
Integrating theories of behavior change into educational interventions at the primary-care level may translate to improved care, reduced long-term complications, and better quality of life.
Background
Foot self-care is key in preventing morbidity in high-risk diabetic patients. Motivational interviewing (MI) is an approach to encourage behavior change by patients that can be used in medical settings. The goal was to explore how podiatric physicians promote self-care in such patients and whether they use MI techniques.
Methods
We conducted a 19-question online survey of US-based practicing podiatric physicians. Most answers were on a 5-point scale. The MI index was the sum of answers to five relevant questions.
Results
Of 843 podiatric physicians, 86% considered foot self-care to be very important for high-risk diabetic patients, and 90% felt that it was their role to discuss foot self-care with them; 49% felt that they had training and were successful in promoting behavior change, but most were definitely (38%) or possibly (46%) interested in learning more. Only 24% of respondents scored at least 15 of 20 on the MI index. Higher MI scores were associated with more face time and more time discussing foot self-care but were not related to podiatric physicians' age, sex, geographic location, percentage of time in surgery, or years in practice. Reported barriers to counseling were lack of reimbursed time and poor patient engagement.
Conclusions
Most podiatric physicians view self-care behavior among high-risk diabetic patients and their role in promoting it as very important; most feel already proficient, but only a few demonstrate MI skills; most are willing to learn more. Success in behavioral counseling, such as MI, is likely to require more time and may be encouraged by a move from fee-for-service to outcome-based reimbursement.
Background
Transtibial (TTA) and transfemoral (TFA) amputations are rarely considered as distinct events when examining major lower-limb amputation outcomes. The objective of this study was to investigate the relationships among type 2 diabetes, diabetes management strategies, hemoglobin A1c levels, and other health factors related to TTA and TFA.
Methods
The retrospective medical record review included abstracting demographic and health-related data from the electronic medical records of 92 patients who received amputation-related services in a Department of Veterans Affairs hospital.
Results
Patients who controlled their diabetes with insulin (with or without other oral agents) were significantly more likely to undergo TTA (adjusted odds ratio [aOR] = 7.63; 95% confidence interval [CI], 1.17–49.97; P = .03) compared with patients who controlled their diabetes through noninsulin medications or by diet. Patients who underwent no previous surgery (aOR = 6.66; 95% CI, 0.89-49.72; P = .06) or partial amputation only (aOR = 15.44; 95% CI, 1.04–228.29; P = .05) compared with a combination of partial amputation and bypass, thrombolectomy, or stent procedures were marginally to statistically significantly more likely to undergo TTA than TFA.
Conclusions
The preferential association between TTA with insulin-dependent diabetes and higher hemoglobin A1c levels versus TFA with previous lower-limb bypasses, stent placement, and thrombolytic interventions distinguishes TTA and TFA as two distinct entities, and awareness of this difference may help clinicians design preventive strategies accordingly.
The primary purpose of this study was to determine the magnitude and duration of plantar pressures acting on the feet of American Indians with diabetes mellitus. A secondary purpose was to determine whether differences in the range of motion of the ankle and first metatarsophalangeal joints existed between American Indians with and without diabetes. Three groups of American Indian subjects were tested: a control group (n = 20); a group with diabetes but no peripheral neuropathy (n = 24); and a group with diabetes and peripheral neuropathy (n = 21). A floor-mounted pressure sensor platform was used to collect plantar pressure data while subjects walked barefoot. The results indicated that American Indians with diabetes have 1) a pattern of peak plantar pressure similar to patterns previously reported for non–American Indians with diabetes and 2) a reduction in ankle and first metatarsophalangeal joint range of motion in comparison with nondiabetic American Indians. (J Am Podiatr Med Assoc 91(6): 280-287, 2001)
Thirty subjects with type 1 diabetes, 30 subjects with type 2 diabetes, and 30 age- and sex-matched controls were evaluated through clinical goniometry and two-dimensional motion analysis systems to determine the dynamic and static range of motion of the knee, ankle, and hallux joints. The purpose of this study was to determine if the knee and ankle joints of patients with diabetes mellitus are affected by limited joint mobility syndrome. The study results support previous medical literature showing significant reduction of range of motion of the hallux in subjects with type 1 diabetes. Significant differences were found between the range of motion of male and female subjects in all lower-limb joints for both subject groups with diabetes compared to the control group, and male subjects in all groups recorded less range of motion than female subjects. (J Am Podiatr Med Assoc 92(3): 136-142, 2002)
Decreasing Amputation Rates in Patients with Diabetes Mellitus
An Outcome Study
The lower-extremity amputation rate in people with diabetes mellitus is high, and the wound failure rate at the time of amputation is as high as 28%. Even with successful healing of the primary amputation site, amputation of part of the contralateral limb occurs in 50% of patients within 2 to 5 years. The purpose of this study was to provide valid outcome data before (control period) and 18 months after (test period) implementation of a multidisciplinary team approach using verified methods to improve the institutional care of wounds. Retrospective medical chart review was performed for 118 control patients and 116 test patients. The amputation rate was significantly decreased during the test period, and the amputations that were required were at a significantly more distal level. No above-the-knee amputations were required in 45 patients during the test period, compared with 14 of 76 patients during the control period. These outcome data suggest that unified care is an effective approach for the patient with diabetic foot problems. (J Am Podiatr Med Assoc 92(8): 425-428, 2002)
Preventive foot-care practices, such as annual foot examinations by a health-care provider, can substantially reduce the risk of lower-extremity amputations. We examined the level of preventive foot-care practices (reported rates of having at least one foot examination by a physician) among patients with diabetes mellitus in North Carolina and determined the factors associated with these practices. Of 1,245 adult respondents to the 1997 to 2001 North Carolina Behavioral Risk Factor Surveillance System, 71.6% reported that they had had their feet examined within the past year, a rate that is much higher than that previously reported by Bell and colleagues in the same population for 1994 to 1995 (61.7%). Foot care was more common among insulin users than nonusers, those having diabetes for 20 years or longer than those having diabetes for less than 10 years, blacks than whites, and those who self-monitored their blood glucose level daily than those who did not. The results of this study indicate that diabetes educational services can be directed at populations at high risk of ignoring the recommended foot-care practices indicated in these analyses, thereby reducing diabetes-related lower-extremity complications. (J Am Podiatr Med Assoc 94(5): 483–491, 2004)
Background
Ankle position sense may be reduced before the appearance of the clinical manifestation of diabetic peripheral neuropathy. This is known to impair gait and cause falls and foot ulcers. Early detection of impaired ankle proprioception is important because it allows physicians to prescribe an exercise program to patients to prevent foot complications.
Methods
Forty-six patients diagnosed as having type 2 diabetes mellitus and 22 control patients were included in the study. Presence of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Level of foot care awareness was determined using the Nottingham Assessment of Functional Footcare (NAFF). Joint position sense was measured using a dynamometer.
Results
Mean absolute angular error (MAAE) values were significantly higher in the neuropathy group compared with the control group (P < .05). Right plantarflexion MAAE values were significantly lower in the group without neuropathy compared with the group with neuropathy (P < .05). No correlation was found between MAAE values (indicating joint position sense) and age, educational level, disease duration, glycemic control, NAFF score, and MNSI history and examination scores in the groups with and without neuropathy (P > .05). Educational level and disease duration were found to be correlated with NAFF scores.
Conclusions
Increased MNSI history scores and increased deficits in ankle proprioception demonstrate that diabetic foot complications associated with reduced joint position sense may be seen at an increased rate in symptomatic patients.
