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- Author or Editor: Stephen Mizzi x
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Abstract
People suffering from diabetes are at risk of developing foot ulcerations, which, if left untreated, could also lead to amputation. Monitoring of the foot temperature can help in the prevention of these foot complications, and various studies have shown that elevated temperatures may be indicative of ulceration. Over the years there have been various devices that were designed for foot temperature monitoring, both for clinical and home use. The technologies used vary from infrared (IR) thermometry, liquid crystal thermography (LCT), IR thermography and a vast range of analogue and digital temperature sensors that were incorporated in different measurement platforms. All these systems are able to collect thermal data from the foot, some being able to acquire data only when the foot is stationary and others being able to acquire from the foot in motion, which can give a more in-depth insight to any emerging problems. The aim of this review is to evaluate the available literature related to the technologies used in these systems, outlining the benefits of each and what further developments may be required to make the foot temperature analysis more effective.
Background:
Elevated dynamic plantar pressures are a consistent finding in diabetic patients with peripheral neuropathy, with implications for plantar foot ulceration. This study aimed to investigate whether a first-ray amputation affects plantar pressures and plantar pressure distribution patterns in individuals living with diabetes and peripheral neuropathy.
Methods:
A nonexperimental matched-subject design was conducted. Twenty patients living with diabetes and peripheral neuropathy were recruited. Group 1 (n = 10) had a first-ray amputation and group 2 (n = 10) had an intact foot with no history of ulceration. Plantar foot pressures and pressure-time integrals were measured under the second to fourth metatarsophalangeal joints, fifth metatarsophalangeal joint, and heel using a pressure platform.
Results:
Peak plantar pressures under the second to fourth metatarsophalangeal joints were significantly higher in participants with a first-ray amputation (P = .008). However, differences under the fifth metatarsophalangeal joint (P = .734) and heel (P = .273) were nonsignificant. Pressure-time integrals were significantly higher under the second to fourth metatarsophalangeal joints in participants with a first-ray amputation (P = .016) and in the heel in the control group (P = .046).
Conclusions:
Plantar pressures and pressure-time integrals seem to be significantly higher in patients with diabetic peripheral neuropathy and a first-ray amputation compared with those with diabetic neuropathy and an intact foot. Routine plantar pressure screening, orthotic prescription, and education should be recommended in patients with a first-ray amputation.
People suffering from diabetes are at risk of developing foot ulcerations which, if left untreated, could also lead to amputation. Monitoring of the foot temperature can help in the prevention of these foot complications, and various studies have shown that elevated temperatures may be indicative of ulceration. Over the years, there have been various devices that were designed for foot temperature monitoring, for both clinical and home use. The technologies used included infrared thermometry, liquid crystal thermography, infrared thermography, and a vast range of analogue and digital temperature sensors incorporated into different measurement platforms. All these systems are able to collect thermal data from the foot, with some being able to acquire data only when the foot is stationary and others being able to acquire data from the foot in motion, which can give more in-depth insight into any emerging problems. The aim of this review is to evaluate the available literature related to the technologies used in these systems, outlining the benefits of each and what further developments may be required to make the foot temperature analysis more effective.
Interrater Reliability of Spectral Doppler Waveform
Analysis Among Podiatric Clinicians
Background:
Spectral Doppler ultrasound examination of pedal arteries is one of the most frequently used noninvasive assessment methods by health-care professionals for the diagnosis and ongoing monitoring of people at risk for or living with peripheral arterial disease. The aim of this study was to determine the interrater reliability of the interpretation of spectral Doppler waveform analysis.
Methods:
An interrater reliability study was conducted among five experienced podiatric physicians at the University of Malta Research Laboratory (Msida, Malta). A researcher who was not a rater in this study randomly selected 229 printed spectral Doppler waveforms from a database held at the University of Malta. Each rater independently rated the qualitative spectral waveforms.
Results:
Interrater reliability of the spectral Doppler waveform interpretation was excellent among the five experienced podiatric physicians (α = 0.98). The intraclass correlation coefficient showed a high degree of correlation in waveform interpretation across raters (P < .001).
Conclusions:
This study demonstrates high interrater reliability in visual spectral Doppler interpretation among experienced clinicians. The current foot screening guidelines do not refer to spectral Doppler waveform analysis in their recommendations, which has been shown in studies to be an important modality for the diagnosis of peripheral arterial disease when ankle-brachial pressure indexes are falsely elevated in calcified arteries. If interpreted correctly, the information obtained can provide an indication of the presence of peripheral arterial disease and facilitate early management of this condition.
