查看更多>>摘要：Over the last 10 years, there have been many notable changes in the healthcare sector. In the NHS, each new policy trend has both characterised and reflected a shift in contemporary political thinking, which has resulted in an almost continual cycle of reform. Workforce issues have dominated the 'modernisation' agenda, and have undoubtedly forced the pace of change.Within the profession of podiatry, change has been equally rapid, and a trawl through the pages of both the British Journal of Podiatry (BJP) and Podiatry Now reveal many of the key events that have occurred across this timeframe.
Wesley VernonAlan M BorthwickJeremy WalkerBob Hardy...
127-133页
查看更多>>摘要：BackgroundThe importance of footwear design in the effective management of many foot disorders is broadly regarded as axiomatic within the podiatric literature, yet little work to date has focused on defining 'healthy' footwear, in respect of its component characteristics and fitting criteria. ObjectivesThis paper reports on the first phase of a study designed to develop a set of nationally applicable criteria for the recognition of 'healthy' footwear. MethodA consensus method was adopted, employing a nominal group technique with purposively sampled 'experts' from within the podiatry and footwear industry. ResultsEleven criteria were identified, with high item agreement between footwear industry and clinical podiatry experts, ranging from suitable heel-block height to key features relating to toebox, lining surfaces and 'slip' (sole material and characteristics). ConclusionsThe national standard will be taken forward into phase 2 of the study, being applied to the current ranges of participating shoe retailers where the efficacy of an introduction to practice will be evaluated.
查看更多>>摘要：Tinea pedis is a common infection of the feet, and is very contagious, transmitted through direct or indirect contact. Theimportance of the prevention of cross-infection to other members of the household and re-infection of the patient has to beaddressed. Footwear and hosiery of the patient may be a source of re-infection. Currently, however, there is a dearth ofevidence-based research in this area.Aim: To establish whether patients with untreated Tinea pedis have fungal contamination within their footwear and hosiery.Method: Thirty patients with suspected tinea pedis were invited to take part in the study. Mycological examination of the skinwas conducted by direct examination and culture. Mycological examination of the footwear and hosiery was conducted usinga touch plate technique employing 55mm contact plates.Results: Out of the 30 subjects, 17 subjects tested positive for skin scrapings. Eighteen subjects were found to have fungalgrowth in their footwear and/ or hosiery.Conclusion: This study demonstrated that patients with untreated tinea pedis have a strong tendency to have fungalcontamination within their footwear and/ or hosiery, although no association was demonstrated by statistical analysis. Thisstudy therefore highlights a need to revisit the area of patient education regarding treatment, not just for the skin alone but also for footwear and hosiery.
查看更多>>摘要：This article was prompted by two recent cases involving patients who had undergone podiatric surgery, one of whom subsequently died. Group A Streptococci (GAS), especially β haemolytic Streptococcus pyogenes, can cause a variety of diseases, the most feared being necrotising fasciitis with multi-organ failure. It is associated with high morbidity and has a mortality rate as high as 80%. Since the 1980s this incidence has increased significantly. The organism appears to be more virulent than in the past, with previously healthy individuals succumbing to life-threatening infection from apparently trivial events. Rapid diagnosis and treatment with antibiotics along with surgical debridement within the intensive care environment is mandatory. This article seeks to illustrate the need for practitioners to become aware of its presentation, diagnosis, treatment and management, as decreasing the time to diagnosis is the main factor in improving survival rates.
查看更多>>摘要：At some point in their professional lives, it is likely that every podiatrist has been, or will be, offered money and gifts from their patients. Despite the ubiquitous nature of the situation, little guidance exists for the podiatrist in practice concerning the ethical and legal implications of accepting these proffered gifts. This review article draws on recent literature in parallel professions and considers the ethical facets of the gift-giving experience, and provides a baseline of considered advice for the podiatrist in practice in what is a highly topical issue. The issues of the type of gift, the situation of the gift giving and the benefits and potential risks of the gift-giving encounter are considered. Conclusions are drawn regarding recommendations for practice.
查看更多>>摘要：Painful feet due to long-standing rheumatoid arthritis are a common problem seen in the department of Podiatric Surgery. These can be managed with conservative treatment, especially in the early stages. In cases with long-standing deformity and disability with poor response to conservative treatment, consideration should be given to surgical correction. There have been many procedures described for the treatment of the rheumatoid forefoot, the commonest involving resection of the metatarsophalangeal joints (MTPJS). Most of these procedures are carried out under general anaesthetic.The authors describe a single case report following 1st MTPJ arthrodesis and resection of the 2nd and 3rd metatarsal heads, under regional anaesthesia by means of an ankle block, for chronic plantar forefoot pain in a patient with longstanding rheumatoid arthritis, unresponsive to conservative care.
查看更多>>摘要：F Scan technology (Tekscan Inc, Boston, MA) and a semantic classification of the weight bearing subtalar joint were used to pursue further understanding of factors that cause plantar ulceration amongst people adversely affected by leprosy. Through this study two hypotheses were tested; both were related to the causal affects of subtalar joint (STJ) pathomechanics and plantar ulceration.Data relating to 144 people was used for this study: 70 were Nepalese (52 male and 18 female), and 74 were Filipino (39 male and 35 female). Feet included in the study had normal skeletal structure (no bone loss) and no apparent loss of muscle function affecting the feet (intrinsic or extrinsic). Data related to 263 feet were used in this study. Three independent groups were analysed: 'normal' (no loss of plantar sensation), 'insensible' (loss of plantar sensation but no loss of skin integrity) and 'impaired skin' (insensibility and ulceration or scars from prior ulceration).Using a simple semantic classification, sub groups of feet were categorised as 'neutral', 'pronated', 'hyper pronated' or 'supinated'. It was found that STJ positions other than 'neutral' were associated with higher forefoot peak pressures, although differences did not reach significance in the 'Insensible' group.Further analysis of feet with loss of sensation, grouped using the semantic classification, revealed risk ratios for ulceration. The relative risk that ulceration would present on 'pronated' or 'superpronated' feet compared with 'neutral' feet was high (5.3 and 2.8 respectively) but 'supinated' feet were not at greater risk of presenting with ulcers than 'neutral' feet.
查看更多>>摘要：Vibration perception threshold (VPT) measurements, obtained with a neurothesiometer, have been identified as reliable and valid indicators for determining the severity of sensory neuropathy in the clinical setting. This study investigates whether a short bout of exercise, immediately prior to testing, will affect VPT thresholds. Fifteen healthy participants were recruited and their VPTs were measured before and after a 15-minute walk on a treadmill. The results provided a two-tailed significance value of 0.032 with a t value of - 2.383, indicating that the exercise intervention raised the VPT of most participants. Therefore, exercise should be considered when collecting normative data for VPTs and when assessing the neurological status of patients.
查看更多>>摘要：Malignant melanoma (MM) is one of the most virulent malignancies to afflict humans, yet it remains an uncommon presentation in the foot. In this article, the authors report on the diagnosis and multidiscipiinary care of such a case arising in the hallux.
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