Podiatry Update

The next ePodiatry Newsletter is online.

Couple of intersting threads at Podiatry Arena:
Is forefoot varus posting an anachronism?
Ankle tourniquet & thalassaemia

Interesting item for sale on eBay:
Vintage Foot Arch Corrector for Quack Podiatry

There has always been a relucntance to use total contact cats on diabetic ischemic ulcers. This latest study in Diabetes Care has shown that moderate ischaemic ulcers do respond:

Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
OBJECTIVE— A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.
RESEARCH DESIGN AND METHODS— Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.
RESULTS— Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P < 0.01). In multivariate analyses, PAD, infection, and heel ulcers were associated with a lower percentage healed (all P < 0.05). Median duration of cast treatment was 34 days. New ulcers, all superfical, developed in 9% and preulcerative lesions in 28% of the patients; these skin lesions healed in the cast within a maximum of 13 days.
CONCLUSIONS— In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.

Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC

From the latest Diabetic Medicine:

Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses

Discussion here.

Many of you know Jim and his acheivements in rheumatoid arthritis and the foot reseach, the in-roads he has made with the gaining of the MRC fellowship - all of which have had major spin-offs and benefits for Podiatry in the UK and further afield.

Now its time to get behind Jim's next adventure - the London Marathon on 17 April .

He is doing it for charity - lets get behind him and donate here: http://www.justgiving.com/woodburn

Discussion, comments and progress reports here: Jim Woodburn and the London Marathon

The next ePodiatry Newsletter is online.

Podiatry Today have some new full text articles available:
New Study Cites Benefits Of Ertapenem For Diabetic Foot Infections.
A Closer Look At Bone Graft Substitutes
How To Determine The Appropriate Level Of Amputation

Podiatry Online have this article on Device Measures Tissue Oxygenation at Wound Site; May Predict Difficult-to-Heal Diabetic Foot Ulcers.

Some new threads at Podiatry Arena:
Podiatry Items at eBay
Off the wall?
Lynco Bio Orthotic Systems
Foot orthoses and asymptomatic pediatric flatfoot

The sad passing of Dr Richard O. Schuster is noted. There have been a number of tributes in Podiatry Management News: Richard O. Schuster, D.P.M. ; Richard O. Schuster, DPM