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Journal of Foot and Ankle Research Oct 2023The first metatarsophalangeal joint is the most common site of osteoarthritis (OA) in the foot and ankle. Intra-articular corticosteroid injections are widely used for...
BACKGROUND
The first metatarsophalangeal joint is the most common site of osteoarthritis (OA) in the foot and ankle. Intra-articular corticosteroid injections are widely used for this condition, but little is known about their use in practice. This study explored current practice within the UK National Health Service (NHS) relating to the administration of intra-articular corticosteroids for people with painful first metatarsophalangeal joint (MTPJ) OA.
METHODS
A cross-sectional survey using Qualtrics online survey platform (Qualtrics, Provo, UT, USA), distributed through professional bodies, special interest groups, and social media.
RESULTS
One hundred forty-four healthcare professionals responded, including podiatrists (53/144; 39%), orthopaedic surgeons (28/144; 19%), podiatric surgeons (26/144; 17%) and physiotherapists (24/144; 16%). Half of respondents administered up to 25 corticosteroid injections per year (67/136; 49%) but some administered more than fifty (21/136; 15%). Injections were administered across the healthcare system but were most common in hospital settings (64/136; 44%) followed by community (38/136; 26%), with less delivered in primary care (11/136; 8%). Half of respondents routinely used image-guidance, either ultrasound or x-ray/fluoroscopy (65/136; 48%) although over one third used none (52/136; 38%). Imaging guidance was more common amongst medical professionals (21/31; 68%) compared to non-medical health professionals (45/105; 43%). Overall, methylprednisolone acetate was the most common corticosteroid used. Medical professionals mostly injected methylprednisolone acetate (n = 15/27; 56%) or triamcinolone acetonide (n = 11/27; 41%), whereas premixed methylprednisolone acetate with lidocaine hydrochloride was the most common preparation used by non-medical health professionals (41/85; 48%). When injecting non premixed steroid, lidocaine hydrochloride (15/35; 43%) was the most common choice of local anaesthetic for non-medical health professionals but medical professionals showed more variation between lidocaine hydrochloride (8/23; 35%) levobupivacaine hydrochloride (9/23; 39%) and bupivacaine hydrochloride (5/23; 22%).
CONCLUSIONS
Multiple professional groups regularly administer intra-articular corticosteroids for symptomatic first MTPJ OA across a range of NHS healthcare settings. Overall, methylprednisolone acetate was the most commonly administered steroid and lidocaine hydrochloride the most common local anaesthetic. There was large variation in the use of imaging guidance, type and dose of steroid, local anaesthetic, and clinical pathways used in the intra-articular injection of corticosteroids for people with first MTPJ OA.
Topics: Humans; Anesthetics, Local; Methylprednisolone Acetate; Cross-Sectional Studies; State Medicine; Adrenal Cortex Hormones; Osteoarthritis; Lidocaine; Injections, Intra-Articular; Metatarsophalangeal Joint; Surveys and Questionnaires; United Kingdom
PubMed: 37845758
DOI: 10.1186/s13047-023-00672-6 -
Journal of Foot and Ankle Research Sep 2023Chronic limb-threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management....
BACKGROUND
Chronic limb-threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management. Guidance recommends urgent referral and assessment, but delays are evident at every stage of the CLTI patient pathway. This study uses qualitative methods to explore hospital clinicians' experiences and perceptions of the existing CLTI pathway.
METHODS
A qualitative interview study was conducted. Semi-structured interviews were undertaken with 13 clinicians involved in the assessment of patients referred to hospital with suspected CLTI, identified via purposive sampling from English vascular surgery units. Clinicians included podiatrists, vascular specialist nurses and doctors. Reflexive thematic analysis was performed on the data from a critical realist position.
RESULTS
The need for speed was the single overarching theme identified. Four linked underlying themes were also identified; 1. Vascular surgery as the poor relation (compared to cancer and other specialties), with a sub-theme of CLTI being a challenging diagnosis. 2. Some patients are more equal than others, with sub-themes of diabetes vs. non-diabetes, hub vs. spoke and frailty vs. non-frail. 3. Life in the National Health Service (NHS) is tough, with sub-themes of lack of resource and we're all under pressure. 4. Non-surgeons can help.
CONCLUSIONS
The underlying themes generated from the rich interview data describe barriers to timely referral, assessment and management of CLTI, as well as the utility of non-surgical roles such as podiatrists and vascular specialist nurses as a potential solution for delays. The overarching theme of the need for speed highlights the meaning given to adverse consequences of delays in management of CLTI by clinicians involved in its assessment. Future improvement projects aimed at the CLTI pathway should take these findings into account.
Topics: Humans; Critical Pathways; Chronic Limb-Threatening Ischemia; State Medicine; Hospitals; Qualitative Research
PubMed: 37726754
DOI: 10.1186/s13047-023-00664-6 -
Cureus Jan 2024A serious kind of fractured foot ailment is a foot crush injury. Foot injury commonly happens in accidents involving transportation or the workplace, such as automobile...
A serious kind of fractured foot ailment is a foot crush injury. Foot injury commonly happens in accidents involving transportation or the workplace, such as automobile accidents, big objects falling on the foot, or heavy machinery running over the foot. Foot crush injuries are more severe than regular foot fractures. These wounds are usually very serious, involving many fractures and soft tissue injuries. The main symptoms include pain, severe muscle and tissue damage, and extreme swelling. Because of this, treating a foot crush injury can be quite challenging and frequently requires the collaboration of physical therapists, orthopedic surgeons, and podiatrists. Physiotherapy is important for reducing pain, increasing range of motion, strengthening muscles, and improving leg function. It also decreases the chance of contractures, deformities, and stiffness following crush injuries. In this report, we present the case of a 58-year-old male with a lacerated wound over his left foot with chief complaints of severe pain. Patient-tailored physiotherapy rehabilitation, including active movements, passive movements, isometric exercises, and a strengthening regimen consisting of numerous repetitions and progressive complexity, was given. At the end of four weeks, the patient had improved strength and quality of life.
PubMed: 38371133
DOI: 10.7759/cureus.52572 -
PloS One 2024We assessed equity in the uptake of remote foot temperature monitoring (RTM) for amputation prevention throughout a large, integrated US healthcare system between 2019...
OBJECTIVE
We assessed equity in the uptake of remote foot temperature monitoring (RTM) for amputation prevention throughout a large, integrated US healthcare system between 2019 and 2021, including comparisons across facilities and between patients enrolled and eligible patients not enrolled in RTM focusing on the Reach and Adoption dimensions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
MATERIAL AND METHODS
To assess whether there was equitable use of RTM across facilities, we examined distributions of patient demographic, geographic, and facility characteristics across facility RTM use categories (e.g., no RTM use, and low, moderate, and high RTM use) among all eligible patients (n = 46,294). Second, to understand whether, among facilities using RTM, there was equitable enrollment of patients in RTM, we compared characteristics of patients enrolled in RTM (n = 1066) relative to a group of eligible patients not enrolled in RTM (n = 27,166) using logistic regression and including all covariates.
RESULTS
RTM use increased substantially from an average of 11 patients per month to over 40 patients per month between 2019 and 2021. High-use RTM facilities had higher complexity and a lower ratio of patients per podiatrist but did not have consistent evidence of better footcare process measures. Among facilities offering RTM, enrollment varied by age, was inversely associated with Black race (vs. white), low income, living far from specialty care, and being in the highest quartiles of telehealth use prior to enrollment. Enrollment was positively associated with having osteomyelitis, Charcot foot, a partial foot amputation, BMI≥30 kg/m2, and high outpatient utilization.
CONCLUSIONS
RTM growth was concentrated in a small number of higher-resourced facilities, with evidence of lower enrollment among those who were Black and lived farther from specialty care. Future studies are needed to identify and address barriers to uptake of new interventions like RTM to prevent exacerbating existing ulceration and amputation disparities.
Topics: Humans; Temperature; Telemedicine
PubMed: 38557772
DOI: 10.1371/journal.pone.0301260 -
Journal of Foot and Ankle Research Jul 2023The UK medicines legislation was amended ten years ago (2013) to allow podiatrists and physiotherapists independent prescribing rights, the first of the allied health...
BACKGROUND
The UK medicines legislation was amended ten years ago (2013) to allow podiatrists and physiotherapists independent prescribing rights, the first of the allied health professions to do so. Non-medical prescribing formed one part of a broader policy agenda promoting role flexibility in response to the challenge of an ageing population and the need to maintain effective health provision in the face of a contracting workforce.
AIM
The aim of this study was to outline the experiences of the Department of Health AHP medicines project board team in working towards independent prescribing for podiatry and physiotherapy, with a particular focus on the challenges encountered.
METHODS
In depth, open-ended interviews were conducted with eight of the core members of the project team, drawn from those individuals who served throughout the duration of the project (2010-2013). Included were the former Department of Health Chief and Deputy Chief Allied Health Professions Officers; the Department of Health Engagement and Communications Officer; representatives of the Health and Care Professions Council; the Medicines and Healthcare products Regulatory Agency; the Council of Deans of Health; the Royal College of Podiatry and the Chartered Society of Physiotherapy (The team also included the representative of the Allied Health Professions Federation. However, as that representative is also a researcher in this study, he has recused himself from any role as a participant.). Data were transcribed and subject to a thematic analysis.
RESULTS
A complex picture of the project emerged revealing a range of obstacles and challenges, including inter-professional role boundary tensions and negative prior assumptions about the two professions. Success hinged upon the adoption of a dual strategy involving submission of a robust case of need focused on patient benefit coupled with the careful management of professional expectations. Underpinning theory from the sociology of the professions offers a supportive explanatory framework for understanding the relationships between the various stakeholders involved.
CONCLUSIONS
Ultimately, success depended upon aligning the project aims with healthcare policy through a clear focus on patient benefit. Balancing competing professional and policy demands through a continual emphasis on improved patient care laid the foundations for future projects by other allied health professions.
Topics: Male; Humans; Delivery of Health Care; Allied Health Personnel; Podiatry; Physical Therapists; United Kingdom
PubMed: 37400869
DOI: 10.1186/s13047-023-00641-z -
Foot (Edinburgh, Scotland) Sep 2023There is no literature to support the existence of an effective standardised assessment tool in South Africa that aids the podiatrist in the early diagnosis of...
UNLABELLED
There is no literature to support the existence of an effective standardised assessment tool in South Africa that aids the podiatrist in the early diagnosis of developmental delay in the paediatric patient from age one to five. Podiatrists in South Africa (SA) need a suitable assessment tool to evaluate child development. A potential proforma that could be used by South African podiatrists is the Gait and Lower Limb Observation Proforma (GALLOP) Assessment Tool.
AIM
The aim of this research was to evaluate the "ease of use" and "usefulness" of the GALLOP Assessment Tool for podiatrists to effectively assess the paediatric patient from age one to age five.
METHODS
The study was of a mixed methods descriptive design type, targeting all Health Professions Council of South Africa (HPCSA) registered podiatrists in the Johannesburg Metropolitan Municipal area. After allowing the participants to use the GALLOP Assessment Tool for a period of time, a survey was conducted to establish the "ease of use" and "usefulness" of the GALLOP Assessment Tool.
RESULTS
All participants agreed that the GALLOP Assessment Tool would be beneficial to South African podiatrists and that the assessment tool does not need to be improved upon.
Topics: Child; Humans; Lower Extremity; Podiatry; South Africa; Surveys and Questionnaires
PubMed: 36990014
DOI: 10.1016/j.foot.2023.102018 -
Journal of Research in Nursing : JRN Dec 2023Diabetic foot ulcers (DFUs) add a significant burden to the lives of people with diabetes in the United Kingdom. They can have a considerable impact on a patient's daily...
BACKGROUND
Diabetic foot ulcers (DFUs) add a significant burden to the lives of people with diabetes in the United Kingdom. They can have a considerable impact on a patient's daily life, with treatment requiring frequent changes of dressings and clinic attendances. Nurses and other allied health professionals (AHPs) within the community provide most wound care representing the primary cost driver.
AIMS
To collaboratively explore key resource use related to the management of DFUs to develop, and pilot, a participant-reported measure to inform economic evaluations.
METHODS
A literature search and semi-structured interviews determined health and non-health resource use in management of DFUs. A consensus view of the selected items was established in a modified Delphi study and further tested for acceptability and validity in a pilot study.
RESULTS
Primary care consultations with a podiatrist or orthotist, district nurse visits, out-of-hours and emergency care, scans and investigations, and consumables provided in clinics were rated as the most important resource use items.
CONCLUSIONS
This work has informed the development of a measure that captures resource use considered important by the people most affected by DFUs; patients, family members and carers, and the healthcare professionals key to DFU management.
PubMed: 38162721
DOI: 10.1177/17449871231208108 -
International Journal of Environmental... Sep 2023Climate change is real and we are witnessing its consequences, such as rising temperatures, water scarcity, and sea-level rise, among other significant impacts. As...
Climate change is real and we are witnessing its consequences, such as rising temperatures, water scarcity, and sea-level rise, among other significant impacts. As healthcare professionals, podiatrists should be concerned about climate change; however, they still contribute to the damage caused. Therefore, the aim of this study was to assess the level of awareness among podiatrists regarding this issue and determine their attitudes toward the climate change process. The study involved conducting a survey comprising a series of questions, including personal information, Likert-scale questions, and short questions to evaluate attitudes toward environmental sustainability in their workplace and how they contribute to the climate change process. The questions addressed their commuting habits to determine sustainability, the number of hours of physical exercise per week, and their clinical attitudes, such as prescribing unnecessary treatments or emphasizing sports as the primary treatment. The results revealed that nearly 89% of the respondents were unaware of ecological podiatry or shoe recycling. Regarding clinical attitudes, 31.1% of the respondents stated that they prescribe sports as the primary treatment for all their patients, while 37.9% do so in most cases. They also tend to avoid prescribing unnecessary treatments, with 44.9% stating that they never prescribe them unless absolutely necessary. In conclusion, based on this survey, Spanish podiatrists do not undertake favorable actions for climate change and lack knowledge of the concept of "ecological podiatry". To improve the situation, efforts should focus on waste reduction, eliminating unnecessary treatments, and promoting and practicing ecological podiatry.
PubMed: 37754620
DOI: 10.3390/ijerph20186761 -
Journal of Foot and Ankle Research Aug 2023Given the importance of preventive care for the lower limb in people with diabetes, and the absence of local guidelines in Aotearoa New Zealand (NZ), the aim of this...
How does the clinical practice of Aotearoa New Zealand podiatrists align with international guidelines for the prevention of diabetes-related foot disease? A cross-sectional survey.
BACKGROUND
Given the importance of preventive care for the lower limb in people with diabetes, and the absence of local guidelines in Aotearoa New Zealand (NZ), the aim of this study was to determine the alignment of assessment and management used in the prevention of diabetes-related foot disease by NZ podiatrists to the international prevention guideline recommendations.
METHODS
A 37-item web-based survey was developed using a 5-point Likert scale (0 = always; 5 = never) based on the International Working Group of the Diabetic Foot (IWGDF) 2019 prevention guidelines and included domains on participant demographics, sector, caseloads, guidelines, screening, management, education, and referral. The survey was distributed to NZ podiatrists through the NZ podiatry association and social media. Participants completing > 50% of items were included. The Mann-Whitney U test was used to examine differences between sector subgroups.
RESULTS
Seventy-seven responses (16.3% of the NZ podiatry workforce) were received, of which 52 completed > 50% of items and were included. Of those 52 podiatrists, 73% were from the private sector. Public sector podiatrists reported higher weekly caseloads of patients with diabetes (p = 0.03) and foot ulcers (p < 0.001). The New Zealand Society for the Study of Diabetes (NZSSD) risk stratification pathway and IWGDF guidelines were the two most frequently utilised guidance documents. Participants reported median scores of at least "often" (< 2) for all items in the assessment and management, inspection, examination, and education provision domains for people with a high-risk foot. More than 50% of respondents reported screening more frequently than guideline recommendations for people with a very low to moderate risk foot. Structured education program was only used by 4 (5%) participants. Public sector podiatrists reported greater provision of custom-made footwear (p = 0.04) and multi-disciplinary team care (p = 0.03).
CONCLUSION
NZ podiatrists generally follow international guideline recommendations with respect to screening, self-care education, appropriate footwear, and treatment of risk factors for people at-risk of diabetes-related foot disease. However there may be over-screening of people with very low to medium risk occurring in clinical practice. Increasing access to integrated healthcare, custom-made footwear and structured educational programmes appear to be areas of practice that could be developed in future to help prevent diabetes-related foot disease in NZ.
Topics: Humans; Cross-Sectional Studies; New Zealand; Foot Diseases; Diabetic Foot; Foot; Diabetes Mellitus
PubMed: 37605269
DOI: 10.1186/s13047-023-00651-x -
Medical Image Analysis May 2024Monitoring the healing progress of diabetic foot ulcers is a challenging process. Accurate segmentation of foot ulcers can help podiatrists to quantitatively measure the...
Monitoring the healing progress of diabetic foot ulcers is a challenging process. Accurate segmentation of foot ulcers can help podiatrists to quantitatively measure the size of wound regions to assist prediction of healing status. The main challenge in this field is the lack of publicly available manual delineation, which can be time consuming and laborious. Recently, methods based on deep learning have shown excellent results in automatic segmentation of medical images, however, they require large-scale datasets for training, and there is limited consensus on which methods perform the best. The 2022 Diabetic Foot Ulcers segmentation challenge was held in conjunction with the 2022 International Conference on Medical Image Computing and Computer Assisted Intervention, which sought to address these issues and stimulate progress in this research domain. A training set of 2000 images exhibiting diabetic foot ulcers was released with corresponding segmentation ground truth masks. Of the 72 (approved) requests from 47 countries, 26 teams used this data to develop fully automated systems to predict the true segmentation masks on a test set of 2000 images, with the corresponding ground truth segmentation masks kept private. Predictions from participating teams were scored and ranked according to their average Dice similarity coefficient of the ground truth masks and prediction masks. The winning team achieved a Dice of 0.7287 for diabetic foot ulcer segmentation. This challenge has now entered a live leaderboard stage where it serves as a challenging benchmark for diabetic foot ulcer segmentation.
Topics: Humans; Diabetic Foot; Neural Networks, Computer; Benchmarking; Image Processing, Computer-Assisted; Diabetes Mellitus
PubMed: 38569380
DOI: 10.1016/j.media.2024.103153