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Qutob RA, Hakami OA, Aldosari L, Alharfi M, Alnader RY, Alomar A, Alaryni A, Alghamdi A, Alsolamy E, Al Harbi K, Alammari Y, Alotay AA, Alhajery MA, Alanazi A. Foot Care Prioritization Among Health Care Providers Treating Diabetic Patients in Saudi Arabia: A Survey-Based Study. Cureus 2023; 15:e50798. [PMID: 38239532 PMCID: PMC10796156 DOI: 10.7759/cureus.50798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Diabetic foot disease (DFD) is a significant complication associated with diabetes, characterized by the potential for progressive amputation of specific foot segments or the entire lower limb in the absence of timely identification of infection and intervention. The aim of our research is to evaluate the degree of importance given to foot care by healthcare professionals who are responsible for treating individuals with diabetes in Riyadh, Saudi Arabia. METHODS This cross-sectional study utilized an online survey previously validated in Australia. The mean foot care prioritization score was used to identify the dummy variable for binary logistic regression analysis, which was used to identify predictors of foot care prioritization. RESULTS A total of 222 participants were involved in this study. Assessing for the risk of developing foot complications, visually inspecting feet for wounds, and providing or recommending footwear to prevent foot complications were the most commonly reported practices, accounting for 80.60% (n = 178), 76.10% (n = 169), and 75.20% (n = 167), respectively. The most commonly referred patients to a specialist tertiary multi-disciplinary foot care team were patients with ulcers in patients with absent foot pulses, ulcers with ascending cellulitis, and diabetic ulceration, accounting for 73.50% (n = 163), 71.60% (n = 159), and 66.70% (n = 148), respectively. The mean foot care prioritization score for the study participants was 54.1 (standard deviation: 11.7) out of 78 (69.4%), which demonstrates a moderately high level of foot care prioritization. Binary logistic regression analysis identified that healthcare professionals who are aged 35-44 years, those who have 5-10 years of experience, those who work at private hospitals, those who have a higher number of practice clinics per week, and those who have to manage a higher number of patients with diabetes in each clinic were more likely to prioritize foot care in their practices (p < 0.05). CONCLUSION Our study found that healthcare professionals in Saudi Arabia place a moderate degree of emphasis on foot care. Healthcare professionals falling within the age range of 35-44 years, possessing 5-10 years of experience, employed at private hospitals, overseeing a greater number of practice clinics weekly, and managing a greater number of patients with diabetes per clinic exhibited a greater propensity to prioritize foot care within their respective practices. Policymakers should consider the integration of continuous glucose monitoring technologies, the establishment of standardized foot screening protocols, and the implementation of targeted educational programs for healthcare professionals.
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Affiliation(s)
- Rayan A Qutob
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Osamah A Hakami
- Department of Internal Medicine, King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah, SAU
| | - Layan Aldosari
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Mohammad Alharfi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Raghad Y Alnader
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulaziz Alomar
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah Alaryni
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah Alghamdi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Eysa Alsolamy
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Khalid Al Harbi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Yousef Alammari
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulwahed Abdulaziz Alotay
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Mohammad A Alhajery
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulrahman Alanazi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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2
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Wang Y, Cai Q, Bai J, Ming Y, Qin W. Perceptions of protective shoes and recommendations from patients with diabetic foot ulcers. Glob Health Med 2023; 5:306-310. [PMID: 37908513 PMCID: PMC10615025 DOI: 10.35772/ghm.2023.01029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/03/2023] [Accepted: 08/28/2023] [Indexed: 11/02/2023]
Abstract
Development of diabetic foot can cause serious harm to a patient's body and pose a heavy burden on family members and society. Protective shoes are of great significance to preventing diabetic foot. The aim of the current study was to understand patients' views and suggestions concerning the selection and promotion of protective shoes for diabetics in order to explore existing obstacles and to provide a reference for improving relevant public health care policies and clinical decision-making for patients with diabetic foot ulcers (DFUs). A total of 10 patients with DFUs were recruited. All participants completed a one-hour semi-structured interview, and results reflected the participants' choice of footwear, the patients' perceptions and acceptance of protective footwear, and factors influencing those processes. The use and promotion of protective shoes in China requires greater support, including improved medical insurance policies, promotion of multidisciplinary cooperation between medicine and industry in clinical practice, and better health education.
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Affiliation(s)
- Yiru Wang
- Department of Nursing, Huadong Hospital Affiliated with Fudan University, Shanghai, China
| | - Qing Cai
- Department of Nursing, Huadong Hospital Affiliated with Fudan University, Shanghai, China
| | - Jiaojiao Bai
- Department of Nursing, Huadong Hospital Affiliated with Fudan University, Shanghai, China
| | - Yue Ming
- Department of Endocrinology, Huadong Hospital Affiliated with Fudan University, Shanghai, China
| | - Wen Qin
- Department of Nursing, Huadong Hospital Affiliated with Fudan University, Shanghai, China
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Ellis S, Branthwaite H, Chockalingam N. Evaluation and optimisation of a footwear assessment tool for use within a clinical environment. J Foot Ankle Res 2022; 15:12. [PMID: 35144665 PMCID: PMC8829975 DOI: 10.1186/s13047-022-00519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
Footwear has been documented as a significant factor in the aetiology of foot pain in the general population. Assessing footwear in a clinical setting continues to be practitioner specific and there is limited guidance to direct advice. Health professionals must have access to clinically appropriate and reliable footwear assessment tools to educate patients on healthier footwear choices. The primary aim of this study was to critique what elements should be in a footwear assessment tool with a secondary aim of testing the agreed tool for validity. A combined Nominal Group Technique and then a Delphi technique from purposively sampled experts of foot health professions were employed to critique elements of footwear assessment. The agreed tool was then tested by practising podiatrists on 5 different shoes to assess the validity and reliability of the measures. Twelve test evaluation criteria were identified receiving significant ratings to form the final footwear assessment tool consisting of five footwear themes. Application of the tool in a clinical setting validated the themes of footwear characteristics, footwear structure, motion control and wear patterns. However, the assessment of footwear fit was not reliable. The footwear tool was refined based on the collective consensus achieved from the rounds creating a more clinically appropriate tool. The validity of this tool was assessed as high in some of the themes but for those that were lower, a training need was identified.
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Affiliation(s)
- Stephen Ellis
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, ST4 2DF, Stoke on Trent, UK
| | - Helen Branthwaite
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, ST4 2DF, Stoke on Trent, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, ST4 2DF, Stoke on Trent, UK
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Lucoveis MDLS, Rolim LCDSP, Pedrosa HC, Roberto de Sá J, Armstrong DG, Boccara de Paula MA, Gamba MA. Development and validation of a pocket guide for the prevention of diabetic foot ulcers. ACTA ACUST UNITED AC 2021; 30:S6-S15. [PMID: 34170740 DOI: 10.12968/bjon.2021.30.12.s6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Diabetic foot ulcers can have serious consequences, including amputation. This project aimed to develop and validate a diabetes care management model-a pocket guide on the prevention of foot ulceration to assist health professionals and scientific societies. METHODS An adaptation of the Iowa method of evidence-based practice to promote high-quality care was employed. After problems are identified, the Iowa method supports the development of an action plan for addressing them. An evidence-based protocol based on the five cornerstones of the 2015 guidance on the diabetic foot by the International Working Group on the Diabetic Foot was developed in two phases and validated using the Delphi technique. RESULTS A model was developed to promote these five cornerstones, which are the main recommendations for managing the diabetic foot. These are: foot examination; risk assessment for ulceration; education in diabetes; appropriate footwear; and treatment of pre-ulcerative lesions. To adapt this into a health information document, the management model was synthesised and designed as a pocket guide. The model's individual and global content validity indices surpass 0.78 and 0.90 respectively. CONCLUSION A management model was created and validated, and produced as a pocket guide to deliver instructions on the care and prevention of diabetic foot problems in people with diabetes.
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Affiliation(s)
| | | | - Hermelinda Cordeiro Pedrosa
- Coordinator, Coordinatory of Research, FEPECS (Health Sciences Teaching and Research Foundation), Endocrinology Unit of Taguatinga Regional Hospital, Health Secretariat, Brasilia, Brazil
| | - João Roberto de Sá
- Affiliate professor, Discipline of Endocrinology and Metabology, Federal University of São Paulo, São Paulo, Brazil
| | - David G Armstrong
- Professor of Surgery and Director, Southwestern Academic Limb Salvage Alliance, Keck School of Medicine of University of Southern California, USA
| | | | - Mônica Antar Gamba
- Associate Professor, Department of Nursing, Federal University of São Paulo, São Paulo, Brazil
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Linton C, Searle A, Hawke F, Tehan PE, Chuter V. Nature and extent of outpatient podiatry service utilisation in people with diabetes undergoing minor foot amputations: a retrospective clinical audit. J Foot Ankle Res 2021; 14:6. [PMID: 33435997 PMCID: PMC7805117 DOI: 10.1186/s13047-020-00445-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background People with diabetes are at high risk of foot complications that can lead to lower extremity amputations. National standards suggest that early assessment and management by a podiatry led multidisciplinary high-risk foot clinic (HRFC) helps to reduce complications. This review is a retrospective audit of the Central Coast Local Health District (CCLHD) podiatry department service utilisation in people with diabetes who had undergone a minor foot amputation. Methods All people with diabetes who had minor foot amputations in the calendar year 2017 in the CCLHD in New South Wales were identified. Podiatry occasions of service from all podiatry service clinics (e.g. general, orthoses, wound, HRFC) and hospital stays for 12 months prior to, and 12 months, post the minor foot amputation were extracted. Results Data on 74 people with diabetes who underwent 85 minor foot amputations were collected. In the 12-month period leading up to their minor foot amputation less than half, 42% (n=31), of the patients had attended any of the available podiatry service clinics within the CCLHD system. Post-amputation and discharge from hospital there was an overall rise of 26% in numbers attending all CCLHD podiatry- led clinics bringing the total to 68% (51). However, attendance at the HRFC rose by only 2% from 16% (n=12) to 18% n= (13). Conclusion This study shows that there was underutilisation of Podiatry Services in the CCLHD in 2017 with some participants not meeting national treatment guidelines for foot health services. Revision of current referral pathways both prior to, during and following hospitalisation and expanding the multidisciplinary HRFC to accommodate the population by providing more accessible locations has since been undertaken to increase service access. Further provision of education to those highlighted to be at high risk has also been implemented.
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Affiliation(s)
- Clare Linton
- BE130 Health Precinct, Brush Road, Ourimbah, NSW, 2258, Australia. .,Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia. .,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, NSW, Australia.
| | - Angela Searle
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Fiona Hawke
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Peta Ellen Tehan
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Vivienne Chuter
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
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Barwick AL, Hurn SE, van Netten JJ, Reed LF, Lazzarini PA. Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study. PLoS One 2019; 14:e0211140. [PMID: 30789920 PMCID: PMC6383933 DOI: 10.1371/journal.pone.0211140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/08/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few studies have investigated if people at risk of foot ulceration actually wear the footwear recommended by best practice guidelines to prevent foot ulceration. This study aimed to investigate the prevalence of, and factors associated with, wearing inadequate outdoor footwear in those with diabetes or peripheral neuropathy in an inpatient population. METHODS This was a secondary analysis of a multi-site cross-sectional study investigating foot conditions in a large representative inpatient population admitted into hospital for any medical reason on one day. A range of explanatory variables were collected from all participants including sociodemographic, medical and foot condition factors. The outcome variable for this study was the self-reported outdoor footwear type worn most by participants outside the house in the year prior to hospitalisation. The self-reported footwear type was then categorised into adequate and inadequate according to footwear features recommended in guidelines for populations at risk of foot ulceration. Logistic regression identified factors independently associated with inadequate footwear in all inpatient participants, and diabetes and neuropathy subgroups. RESULTS Overall, 47% of a total of 726 inpatients wore inadequate outdoor footwear; 49% of the 171 in the diabetes subgroup and 43% of 159 in the neuropathy subgroup. Wearing inadequate outdoor footwear was independently associated (Odds Ratio (95% Confidence Interval)) with being female in the diabetes (2.7 (1.4-5.2)) and neuropathy subgroups (3.7 (1.8-7.9)) and being female (5.1 (3.7-7.1)), having critical peripheral arterial disease (2.5 (1.1-5.9)) and an amputation (0.3 (0.1-0.7)) in all inpatients (all, p<0.05). CONCLUSIONS Almost half of all inpatients at risk of foot ulceration reported wearing outdoor footwear most of the time that did not meet recommendations for prevention. We found women were much more likely to wear inadequate footwear. More work needs to be done to increase the uptake of footwear recommendations in these populations to prevent foot ulceration.
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Affiliation(s)
- Alex L. Barwick
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia
| | - Sheree E. Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jaap J. van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
- Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Lloyd F. Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Footmotion Podiatry Brisbane, Queensland, Australia
| | - Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- * E-mail:
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7
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Barwick AL, van Netten JJ, Reed LF, Lazzarini PA. Independent factors associated with wearing different types of outdoor footwear in a representative inpatient population: a cross-sectional study. J Foot Ankle Res 2018; 11:19. [PMID: 29854004 PMCID: PMC5975543 DOI: 10.1186/s13047-018-0260-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/25/2018] [Indexed: 01/27/2023] Open
Abstract
Background Footwear can have both a positive and negative impact on lower limb health and mobility across the lifespan, influencing the risk of foot pain, ulceration, and falls in those at risk. Choice of footwear can be influenced by disease as well as sociocultural factors, yet few studies have investigated the types of footwear people wear and the profiles of those who wear them. The aim of this study was to investigate the prevalence and factors associated with outdoor footwear type worn most often in a representative inpatient population. Methods This study was a secondary data analysis of a cohort of 733 inpatients that is highly representative of developed nations’ hospitalised populations; 62 ± 19 years, 55.8% male, and 23.5% diabetes. Socio-demographic, medical history, peripheral arterial disease, peripheral neuropathy, foot deformity, foot ulcer history, amputation history and past foot treatment variables were collected. Participants selected the footwear type they mostly wore outside the house in the previous year from 16 types of footwear. Multivariate logistic regression identified independent factors associated with outdoor footwear types selected. Results The most common outdoor footwear types were: running shoes (20%), thongs/flip flops (14%), walking shoes (14%), sandals (13%) and boots (11%). Several socio-demographic, medical history and foot-related factors were independently associated (Odds Ratio; 95% Confidence Interval)) with different types of footwear. Running shoes were associated with male sex (2.7; 1.8–4.1); thongs with younger age (0.95 for each year; 0.94–0.97), being female (2.0; 1.2–3.1) and socio-economic status (3.1; 1.2–7.6); walking shoes with arthritis (1.9; 1.2–3.0); sandals with female sex (3.8; 2.3–6.2); boots with male sex (9.7; 4.3–21.6) and inner regional (2.6; 1.3–5.1) and remote (3.4; 1.2–9.5) residence (all, p < 0.05). Conclusions We profiled the types of outdoor footwear worn most in a large diverse inpatient population and the factors associated with wearing them. Sex was the most consistent factor associated with outdoor footwear type. Females were more likely to wear thongs and sandals and males boots and running shoes. Overall, this data gives insights into the socio-demographic, medical and other health factors that are related to footwear choice in a large diverse population primarily of older age. Electronic supplementary material The online version of this article (10.1186/s13047-018-0260-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex L Barwick
- 1School of Health and Human Sciences, Southern Cross University, Southern Cross Drive, Bilinga, QLD 4225 Australia
| | - Jaap J van Netten
- 2School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD Australia.,4Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia
| | - Lloyd F Reed
- 2School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD Australia
| | - Peter A Lazzarini
- 2School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia.,Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, QLD Australia
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van Netten JJ, Lazzarini PA, Armstrong DG, Bus SA, Fitridge R, Harding K, Kinnear E, Malone M, Menz HB, Perrin BM, Postema K, Prentice J, Schott KH, Wraight PR. Diabetic Foot Australia guideline on footwear for people with diabetes. J Foot Ankle Res 2018; 11:2. [PMID: 29371890 PMCID: PMC5769299 DOI: 10.1186/s13047-017-0244-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this paper was to create an updated Australian guideline on footwear for people with diabetes. Methods We reviewed new footwear publications, (inter)national guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline to formulate updated recommendations. Result We recommend health professionals managing people with diabetes should: (1) Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet. (2) Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction. (3) Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent foot ulceration. (4) Instruct people with diabetes at intermediate- or high-risk of foot ulceration to obtain footwear from an appropriately trained professional to ensure it fits, protects and accommodates the shape of their feet. (5) Motivate people with diabetes at intermediate- or high-risk of foot ulceration to wear their footwear at all times, both indoors and outdoors. (6) Motivate people with diabetes at intermediate- or high-risk of foot ulceration (or their relatives and caregivers) to check their footwear, each time before wearing, to ensure that there are no foreign objects in, or penetrating, the footwear; and check their feet, each time their footwear is removed, to ensure there are no signs of abnormal pressure, trauma or ulceration. (7) For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include custom-made in-shoe orthoses or insoles. (8) For people with a healed plantar foot ulcer, prescribe medical grade footwear with custom-made in-shoe orthoses or insoles with a demonstrated plantar pressure relieving effect at high-risk areas. (9) Review prescribed footwear every three months to ensure it still fits adequately, protects, and supports the foot. (10) For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers. Conclusions This guideline contains 10 key recommendations to guide health professionals in selecting the most appropriate footwear to meet the specific foot risk needs of an individual with diabetes.
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Affiliation(s)
- Jaap J van Netten
- 1School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia
| | - Peter A Lazzarini
- 1School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD Australia
| | - David G Armstrong
- 5Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ USA
| | - Sicco A Bus
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Robert Fitridge
- Diabetic Foot Australia, Brisbane, QLD Australia.,7Vascular Surgery, The University of Adelaide, Adelaide, South Australia Australia
| | - Keith Harding
- 8University Dean of Clinical Innovation, Professor of Wound Healing Research, Cardiff University, Cardiff, UK
| | - Ewan Kinnear
- Diabetic Foot Australia, Brisbane, QLD Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD Australia
| | - Matthew Malone
- Diabetic Foot Australia, Brisbane, QLD Australia.,9High Risk Foot Service, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW Australia
| | - Hylton B Menz
- 10Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC Australia
| | - Byron M Perrin
- Diabetic Foot Australia, Brisbane, QLD Australia.,11La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, VIC Australia
| | - Klaas Postema
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jenny Prentice
- Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Consultant, Trojan Health, Perth, WA Australia
| | - Karl-Heinz Schott
- 14School of Health and Human Sciences (Pedorthics) Southern Cross University Gold Coast Campus, Bilinga, QLD Australia
| | - Paul R Wraight
- Diabetic Foot Australia, Brisbane, QLD Australia.,15Diabetic Foot Unit, Royal Melbourne Hospital, Melbourne, VIC Australia
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Al-Kaabi JM, Al Maskari F, Cragg P, Afandi B, Souid AK. Illiteracy and diabetic foot complications. Prim Care Diabetes 2015; 9:465-472. [PMID: 26027780 DOI: 10.1016/j.pcd.2015.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diabetes is especially common in the United Arab Emirates. Its complications in patients residing in the region have yet to be fully explored. This study reports on foot problems in our diabetic patients, with emphasis on the impact of illiteracy on foot care and complications due to diabetes. METHODS Adults were randomly recruited from the Diabetes Center at Tawam-John Hopkins affiliated hospital. A questionnaire addressing foot care and problems was completed for all patients. In addition, an examination was performed by a trained nurse, an endocrinologist, and a podiatrist. RESULTS Four hundred twenty-two adults with type 2 (93%) or type 1 (7%) diabetes were enrolled; 67% were females. Patients' mean age was 52 ± 13 years and duration of diabetes ≥ 1 year. Illiterate patients were 51% and were less likely to practice foot care (p=0.002), recognize foot risk factors (p=0.004), use proper footwear (p=0.010), and being physically active (p<0.001). In addition, they were more likely to have diabetic complications, such as neuropathy (p=0.027), eye disease (p=0.032), hypertension (p<0.001), obesity (p=0.003), increased body fat percentage (p<0.001), reduced capillary refill time (p=0.002), reduced monofilament (p=0.003), and reduced vibration (p<0.001). Logistic regression analysis revealed literates [OR=2.4, CI=1.1-5.4, p=0.031], female gender [OR=2.7, CI=1.1-6.2, p=0.023], and history of foot ulcer [OR=6.0, CI=2.1-17.2, p=0.001] were predictors of practicing foot care. CONCLUSION Illiteracy invoked significant challenges to diabetic attentiveness and imposed increased foot complications. Physicians should realize that illiterate patients are vulnerable and require effective strategies to improve their education about the disease and reduce their diabetic complications.
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MESH Headings
- Adult
- Aged
- Arabs/psychology
- Chi-Square Distribution
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/ethnology
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/ethnology
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Diabetic Foot/diagnosis
- Diabetic Foot/ethnology
- Diabetic Foot/prevention & control
- Diabetic Foot/psychology
- Female
- Health Knowledge, Attitudes, Practice/ethnology
- Health Literacy
- Humans
- Logistic Models
- Male
- Middle Aged
- Multivariate Analysis
- Odds Ratio
- Patient Education as Topic
- Risk Assessment
- Risk Factors
- Risk Reduction Behavior
- Self Care
- Surveys and Questionnaires
- United Arab Emirates/epidemiology
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Affiliation(s)
- Juma M Al-Kaabi
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University , Al-Ain, United Arab Emirates.
| | - Fatma Al Maskari
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Paul Cragg
- Diabetes Center, Tawam-John Hopkins Hospital, Al-Ain, United Arab Emirates
| | - Bachar Afandi
- Diabetes Center, Tawam-John Hopkins Hospital, Al-Ain, United Arab Emirates
| | - Abdul-Kader Souid
- Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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Hendry GJ, Gibson KA, Pile K, Taylor L, du Toit V, Burns J, Rome K. Provision of foot health services for people with rheumatoid arthritis in New South Wales: a web-based survey of local podiatrists. J Foot Ankle Res 2013; 6:35. [PMID: 23972081 PMCID: PMC3765430 DOI: 10.1186/1757-1146-6-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/22/2013] [Indexed: 12/03/2022] Open
Abstract
Background It is unclear if podiatric foot care for people with rheumatoid arthritis (RA) in New South Wales (NSW) meets current clinical recommendations. The objective of this study was to survey podiatrists’ perceptions of the nature of podiatric foot care provision for people who have RA in NSW. Methods An anonymous, cross-sectional survey with a web-based questionnaire was conducted. The survey questionnaire was developed according to clinical experience and current foot care recommendations. State registered podiatrists practising in the state of NSW were invited to participate. The survey link was distributed initially via email to members of the Australian Podiatry Association (NSW), and distributed further through snowballing techniques using professional networks. Data was analysed to assess significant associations between adherence to clinical practice guidelines, and private/public podiatry practices. Results 86 podiatrists participated in the survey (78% from private practice, 22% from public practice). Respondents largely did not adhere to formal guidelines to manage their patients (88%). Only one respondent offered a dedicated service for patients with RA. Respondents indicated that the primary mode of accessing podiatry was by self-referral (68%). Significant variation was observed regarding access to disease and foot specific assessments and treatment strategies. Assessment methods such as administration of patient reported outcome measures, vascular and neurological assessments were not conducted by all respondents. Similarly, routine foot care strategies such as prescription of foot orthoses, foot health advice and footwear were not employed by all respondents. Conclusions The results identified issues in foot care provision which should be explored through further research. Foot care provision in NSW does not appear to meet the current recommended standards for the management of foot problems in people who have RA. Improvements to foot care could be undertaken in terms of providing better access to examination techniques and treatment strategies that are recommended by evidence based treatment paradigms.
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Affiliation(s)
- Gordon J Hendry
- School of Science & Health, University of Western Sydney, Penrith, NSW, Australia.
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