Search Results
This 6-month prospective study investigated the outcomes of foot surgery performed by Fellows of the Australian College of Podiatric Surgeons. The study recruited 140 patients who were treated for orthopedic, neurological, or integumentary diseases of the foot. The majority of subjects who underwent podiatric surgery experienced significant postoperative improvements in a range of health-related quality-of-life dimensions as measured by the disease-specific Foot Health Status Questionnaire (FHSQ) and the generic Short Form 36 (SF-36) questionnaire. Subjects reported a reduction in foot pain, increased levels of physical function, improved general foot health perception, and improved footwear-related quality of life. No significant adverse outcomes or unplanned re-admissions to the hospital were reported. This study demonstrates the advantage of assessing health-related quality of life as opposed to patient satisfaction. (J Am Podiatr Med Assoc 91(4): 164-173, 2001)
Background: Chronic plantar heel pain (CPHP) is common and is thought to have a detrimental impact on health-related quality of life. However, no study has used normative data or a control data set for comparison of scores. Therefore, we describe the impact of CPHP on foot-specific and general health-related quality of life by comparing CPHP subjects with controls.
Methods: Foot Health Status Questionnaire scores were compared in 80 subjects with CPHP and 80 sex- and age-matched controls without CPHP.
Results: The CPHP group demonstrated significantly poorer foot-specific quality of life, as evidenced by lower scores on the foot pain, foot function, footwear, and general foot health domains of the Foot Health Status Questionnaire. The group also demonstrated significantly poorer general health-related quality of life, with lower scores on the physical activity, social capacity, and vigor domains. In multivariate analysis, CPHP remained significantly and independently associated with Foot Health Status Questionnaire scores after adjustment for differences in body mass index. Age, sex, body mass index, and whether symptoms were unilateral or bilateral had no association with the degree of impairment in people with CPHP.
Conclusion: Chronic plantar heel pain has a significant negative impact on foot-specific and general health-related quality of life. The degree of negative impact does not seem to be associated with age, sex, or body mass index. (J Am Podiatr Med Assoc 98(4): 283–289, 2008)
Abstract
Background: It’s well known fact that Hallux valgus (HV) alternates foot biomechanics. In different populations HV and postural stability has been studied but HV and adolescent ballet dancer has not been studied. Aim of the our study is to explore affect of HV on adolescent ballet dancers’ balance. Also we wanted to explore health related quality of life of adolescent ballet dancers with HV.
Methods: Ballets aged between 8-16 years old has been screened prospectively. The dancers divided into two groups group 1;Ballets with HV and group 2; Ballets without HV. HV diagnosis was made clinically. Two groups were compared according to balance parameters and health related quality of life (HRQOL) questionaires.
Results: Group 1 was formed with 31 participants and group 2 was formed with 24 participants. All participants in both groups were female. Mean age in group 1 was 11.6 (8-16 years old) and 12.2 (8-16 years old) in group 2. Mean first metatarsophalangeal angle was 13.4° (10°-15°) in group 2 and 19.8° (16°-25°) in HV group respectively. A statistically significant difference was found according to the nonparametric Mann Whitney U test results in the comparison of HVA (Hallux Valgus Angle) between groups. According to Spearman Rho correlation analysis, it was determined that the increase in HVA caused deterioration in the static Flamingo test. (r=0.552 p=0.019). No significant relationship was found between HRQoL questionaries and the presence of HV. (p>0,05)
Conclusions: Adolescent ballet dancers experience static balance impairment due to HV angle increase. Clinical measurement of HV and application of balance parameters made easy without need of set ups to perform evaluation with high numbers of participants in concordance with literature.
Background: It is well-known that hallux valgus (HV) alters foot biomechanics. In different populations, HV and postural stability has been studied, but HV and the adolescent ballet dancer has not been studied. The aims of this study were to explore the effect of HV on adolescent ballet dancers’ balance and to assess the health-related quality of life (HRQOL) of adolescent ballet dancers with HV.
Methods: Female ballet dancers aged 8 to 16 years were screened prospectively and divided into two groups: those with HV (group 1) and those without HV (group 2). The HV diagnosis was made clinically. The groups were compared according to balance parameters and HRQOL questionnaires.
Results: In group 1 (n = 31) and group 2 (n = 24), the mean age was 11.6 years and 12.2 years, respectively. Mean first metatarsophalangeal angle was 13.4° (range, 10°–15°) in group 2 and 19.8° (range, 16°–25°) in group 1. A statistically significant difference was found according to the nonparametric Mann-Whitney U test results in the comparison of HV angle between groups. According to Spearman rho correlation analysis, it was determined that the increase in HV angle caused deterioration in the flamingo static balance test (r = 0.552; P = .019). No significant relationship was found between HRQOL questionnaires and the presence of HV (P > .05).
Conclusions: Adolescent ballet dancers experience static balance impairment due to HV angle increase. Clinical measurement of HV and application of balance parameters made easy without need of set ups to perform evaluation with high numbers of participants in concordance with the literature.
Physical and Mechanical Therapies for Lower-Limb Problems in Juvenile Idiopathic Arthritis
A Systematic Review with Meta-Analysis
Background:
Juvenile idiopathic arthritis (JIA), a chronic, autoimmune, inflammatory joint disease, is the most common arthritis affecting children younger than 16 years. Children with JIA commonly experience lower-limb dysfunction and disability. We systematically reviewed the effectiveness of physical and mechanical therapies for lower-limb problems in JIA.
Methods:
Randomized controlled trials of physical and mechanical interventions for lower-limb problems in children with JIA were included. Primary outcome was pain. Secondary outcomes included disability, functional ability, and health-related quality of life. Several databases were searched for eligible studies. Authors of included studies and researchers in the field were contacted to identify additional studies.
Results:
Two studies evaluating the effectiveness of customized/custom foot orthoses in treating foot and ankle pain in children with JIA (N = 100) were included. One study also evaluated simple cushioned inserts. Meta-analyses for comparisons between custom/customized foot orthoses and a control intervention after 3 months were not significant for the outcomes of pain (mean difference, –8.97; 95% confidence interval [CI], –18.01 to 0.07), child-rated health-related quality of life (mean difference, 4.38; 95% CI, –3.68 to 12.44), and parent-rated health-related quality of life (mean difference, 1.77; 95% CI, –6.35 to 9.90). Meta-analyses were supported by sensitivity analyses.
Conclusions:
There is a paucity of research evaluating physical and mechanical therapies for lower-limb problems in JIA. No physical therapy has been evaluated in randomized controlled trials, and mechanical therapy evaluation is limited to foot orthoses and shoe inserts for foot and ankle pain. The existing research is hampered by small sample sizes. Until further research is conducted, the effectiveness of mechanical and physical therapies for lower-limb problems in JIA remains unclear.
Podiatric Adverse Events and Foot Care in Cancer Patients and Survivors
Awareness, Education, and Literature Review
Cancer is one of the leading causes of mortality and morbidity worldwide. Recent improved therapies have resulted in more patients surviving cancer and living longer. Despite these advances, the majority of patients will develop adverse events from anticancer therapies. Foot alterations, including nail toxicities, hand-foot syndrome, edema, xerosis, hyperkeratosis, and neuropathy, are frequent among cancer patients. These untoward conditions may negatively impact quality of life, and in some cases may result in the interruption or discontinuation of cancer treatments. Appropriate prevention, diagnosis, and management of podiatric adverse events are essential to maintain foot function and health-related quality of life, both of which are critical for the care of cancer patients and survivors. This article shows results related to complaint and impact on quality of life of the Oncology Foot Care program and reviews publications specific to podiatric adverse events related to cancer treatments.
Background
Health-related quality of life (QOL) is defined as a patient's subjective perception of his or her own health. Insufficient data exist on QOL of patients who undergo a hallux valgus (HV) operation. We used a 36-item short form survey (SF-36) to measure QOL of such patients. Our aim was to evaluate the effect of HV on QOL and to identify QOL determinants.
Methods
Fifty patients who underwent surgery for HV between 2015 and 2017 were included in the study. The SF-36 questionnaire was applied to the patients before and after surgery. Patients' medical records were examined to identify possible factors affecting QOL such as age, gender, body mass index, duration of symptoms, or smoking.
Results
The mean age of the patients was 55.6 ± 3.8 years, and 42 of the 50 patients were women. The mean duration of disease was 12 ± 3.7 years. The surgery improved QOL scores for general health, emotional well-being, role limitations due to personal or emotional problems, physical functioning and bodily pain. However, the changes in scores for vitality and social functioning were not statistically significant. Lower postoperative QOL scores for emotional well-being and bodily pain were significantly associated with age and duration of the symptoms. Compared to the mean QOL of healthy adult Turkish population, all scores in subdimensions were lower.
Conclusions
This study shows that HV in adults has a negative impact on general health, bodily pain, physical functioning, physical and emotional well-being rather than social well-being and vitality.
Dosing Activity and Return to Preulcer Function in Diabetes-Related Foot Ulcer Remission
Patient Recommendations and Guidance from the Limb Preservation Consortium at USC and the Rancho Los Amigos National Rehabilitation Center
Diabetes-related foot ulcers are a leading cause of global morbidity, mortality, and health-care costs. People with a history of foot ulcers have a diminished quality of life attributed to limited walking and mobility. One of the largest concerns is ulceration recurrence. Approximately 40% of patients with ulcerations will have a recurrent ulcer in the year after healing, and most occur in the first 3 months after wound healing. Hence, this period after ulceration is called “remission” due to this risk of reulceration. Promoting and fostering mobility is an integral part of everyday life and is important for maintaining good physical health and health-related quality of life for all people living with diabetes. In this short perspective, we provide recommendations on how to safely increase walking activity and facilitate appropriate off-loading and monitoring in people with a recently healed foot ulcer, foot reconstruction, or partial foot amputation. Interventions include monitored activity training, dosed out in steadily increasing increments and coupled with daily skin temperature monitoring, which can identify dangerous “hotspots” prone to recurrence. By understanding areas at risk, patients are empowered to maximize ulcer-free days and to enable an improved quality of life. This perspective outlines a unified strategy to treat patients in the remission period after ulceration and aims to provide clinicians with appropriate patient recommendations based on best available evidence and expert opinion to educate their patients to ensure a safe transition to footwear and return to activity.
Outcomes research has become a high priority for the podiatric medical profession, according to the results of a recent survey of members of the American Podiatric Medical Association (APMA). The methods of population-based studies using claims data, health-related quality-of-life measures, decision and cost-effectiveness analysis, and quality improvement are discussed and their contributions to the podiatric medical profession highlighted. The integration of this methodology into the podiatric medical literature has been sparse. Future work needs to address the training of future researchers in these methods, the establishment of collaborative arrangements, and the development of uniform clinical and health-related quality-of-life measures.
Background: We assessed the tolerability and efficacy of autologous skin cell grafts in older type 2 diabetic patients with chronic foot ulcers.
Methods: Treatment with Hyalograft 3D and Laserskin Autograft was proposed to a consecutive series of type 2 diabetic patients older than 65 years affected by long-standing (>6 months) foot ulcers with an area greater than 15 cm2. Ulcer healing rates and measurements of ulcer area were determined monthly for 12 months.
Results: Seven patients with 12 ulcers, nine of which received the described treatment, were enrolled. During 12-month follow-up, all of the ulcers healed except one. In the remaining eight ulcers, the median healing time was 21 weeks (interquartile range, 4–29 weeks).
Conclusions: Autologous skin cell grafts are feasible, well tolerated, and apparently effective in the treatment of diabetic ulcers of the lower limbs in advanced age. Age did not seem to moderate healing times. (J Am Podiatr Med Assoc 101(1): 55–58, 2011)
