Hemorheology, ankle brachial pressure index (ABPI) and toe brachial pressure index (TBPI) in metabolic syndrome.

INTRODUCTION: Microvascular dysfunction is associated with metabolic syndrome (MetS) and its components. The objective of our study was to assess macro and microvascular abnormalities in MetS and compare the strength of association of the ankle brachial pressure index (ABPI), toe brachial pressure index (TBPI) and hemorheological parameters with MetS. MATERIALS AND METHODS: 100 participants were recruited from a rural Australian town. Anthropometric measurements were taken along with blood pressures (BP) at the arm, the ankle and the big toe for calculating ABPI and TBPI. Whole blood viscosity (WBV), erythrocyte aggregation, erythrocyte deformability, lipid profile and blood sugar level were analyzed. Recruited participants were classified into MetS and non-MetS following National Cholesterol Education Program Adult Treatment Panel III definition. Data were analyzed by IBM SPSS 20 software. RESULTS: WBV and erythrocyte aggregation were higher whereas erythrocyte deformability was lower in participants with MetS when compared to participants without MetS. Age, sex and diabetes mellitus adjusted odds ratio for predicting MetS was not significant for ABPI and TBPI whereas it was significant for hemorheological parameters. Receiver Operating Characteristics curve showed that TBPI better classified MetS than ABPI but association of hemorheological parameters was superior to that of ABPI and TBPI with MetS. CONCLUSIONS: Both microcirculation defects and macrovascular circulation defects were present in MetS. The concurrences of the components of MetS could have an additive effect in enhancing alterations in hemorheological parameters which may give rise to severe microvasculopathy. The association of hemorheological parameters was stronger than the association of TBPI and ABPI with MetS.

Postoperative infection rates in foot and ankle surgery: a clinical audit of Australian podiatric surgeons, January to December 2007.

BACKGROUND: Surgical site infections are one of the most common post-operative complications encountered by foot and ankle surgeons. The incidence reported in the literature varies between 0.5 and 6.5%. The results of a 12-month Australia-wide clinical audit analysing the rates of postoperative infections in association with podiatric surgery are presented. METHODS: De-identified patient data was collected from nine podiatric surgeons Australia-wide. Infections were identified according to Australian Council on Health Care Standards (ACHS) definitions and data was entered no earlier than thirty days post procedure. RESULTS: A total of 1339 patient admissions and 2387 surgical procedures were reported using the International Classification of Diseases (ICD-10) and Medicare Benefit Schedule (MBS) coding systems. The overall infection rate was 3.1% and the rate of infection resulting in hospital re-admission was 0.25%. CONCLUSIONS: The benchmark results presented in this paper suggest that infection rates associated with podiatric surgery are well within accepted industry standards as stated in recent literature.

Knowledge, beliefs, and use of complementary and alternative medicine by Australian podiatric physicians.

BACKGROUND: Complementary and alternative medicine (CAM) is one of the fastest growing areas of health care. This has necessitated an increased awareness and understanding of CAM by conventional health professionals. METHODS: A questionnaire seeking information about use of and attitudes toward CAM was mailed to 1,365 Australian podiatric physicians. RESULTS: Ninety-one percent of Australian podiatric physicians surveyed have used at least one CAM therapy in the past 12 months, and 93% have treated patients with CAM or have recommended its use to patients. Overall, the respondents rated their knowledge of various CAM therapies as "average," and responses on the CAM Health Belief Questionnaire indicated that respondents tended not to endorse CAM health beliefs, with statements about CAM therapies being seen as "a threat to public safety" and effects being "usually due to the placebo effect" producing the strongest responses. CONCLUSIONS: Complementary and alternative medicine therapies are already being used in podiatric medical practice, and there are significant opportunities for further research into CAM education and clinical research relevant to podiatric medicine.

The influence of transcutaneous electrical nerve stimulation parameters on the level of pain perceived by participants with painful diabetic neuropathy: A crossover study.

AIMS: This pilot study aimed to investigate and compare the perceived pain relief effectiveness of two different modes of TENS in people with painful diabetic neuropathy (PDN). METHODS: A cross-over study was conducted at Charles Sturt University, Orange. Five participants with PDN were assessed with a McGill Pain Questionnaire before and after each of the two TENS treatments. Participants were randomly allocated to Traditional TENS (80Hz, 200ms) or Acupuncture-like TENS (2Hz, 200ms) and the treatments were applied daily for 30min over ten days. Following a seven day washout period, the alternate mode of TENS was carried out using the same method. Wilcoxon Signed Rank tests were used to statistically analyse the results. RESULTS: All five participants reported personally meaningful pain relief during one or both of the TENS treatments. The Wilcoxon signed rank testing showed no statistical significance, p=1, likely due to the small sample size. Acupuncture-like TENS had a large effect size (z=-1.625, r=0.514), whilst Traditional TENS produced a medium effect size (z=-1.214, r=0.384). No adverse effects were reported. CONCLUSION: Acupuncture-like TENS may be more effective for PDN than traditional TENS. A larger scale replication of this pilot study is warranted.

Hemorheological parameters better classify metabolic syndrome than novel cardiovascular risk factors and peripheral vascular disease marker.

The present study compares the association of Metabolic Syndrome (MetS) with hemorheological parameters, oxidative stress, inflammation and peripheral arterial disease markers. 100 participants were recruited and participants were divided into three groups on the basis of absence or presence of MetS and its components. Odds ratio for correctly predicting MetS was highest for erythrocyte aggregation followed by erythrocyte deformability. ROC curve analysis demonstrated that all the hemorheological components significantly classified MetS participants. Area Under Curve was higher for the hemorheological parameters (erythrocyte aggregation and erythrocyte deformability) than for the oxidative stress, inflammation and peripheral arterial disease markers. The possibilities of the hemorheological components to be identified as better cardiovascular risk markers due to their strong association with MetS cannot be precluded from the present findings.

Plantar pressure and radiographic changes to the forefoot after the Austin bunionectomy.

We describe the effects of the Austin bunionectomy on plantar pressure distribution and radiographic measurements in the forefoot in 31 subjects (44 feet) with mild-to-moderate hallux valgus deformity and 36 control subjects (36 feet). Plantar pressure measurements before and 24 months after surgery showed peak pressure beneath the hallux reduced to normal values. Peak pressure measurements beneath the first, second, and third metatarsal heads in hallux valgus feet were relatively unchanged after surgery and remained higher than normal values. The operation produced significant decreases in mean preoperative radiographic measurements of hallux abductus, metatarsus primus varus, and first metatarsal protrusion distance in these patients to below-normal values.

A new concept of indexing tibiofibular torsion: a pilot study using dry bones.

A newly developed clinical method of indexing tibial torsion uses the medial surface of the tibia as the proximal reference; however, the selection of a specific landmark on the medial surface has not been justified. Three different surfaces relating to the tibial tuberosity were tested using 24 dry tibial bones to determine which provides the most accurate and reliable landmark for use as the proximal reference. The medial surface of the tibia at the inferior point of the tibial tuberosity was the most reliable proximal reference that yielded the highest level of association between the newly developed clinical method and true tibial torsion (r = 0.77). The new method has the potential to describe the anatomy of the leg and to improve the clinical measurement of tibiofibular torsion.

Occupational stress among Australian podiatric physicians in general and geriatric practice.

BACKGROUND: High levels of occupational stress have been reported in podiatric physicians practicing in Australia. One possible stressor is the predominance of the treatment of aged patients with chronic disease in podiatric medical practice. METHODS: Forty podiatric physicians attending a regional podiatric medical conference were invited to participate in the research using a convenience sampling method. Podiatric physicians were asked to complete a survey examining occupational stress in general and specifically in relation to practice with older adults (defined as those older than 65 years). RESULTS: The survey of sources of occupational stress among podiatrists identified patient demands and expectations as the most significant stressor in general and geriatric practice for the podiatric physician. The perceived limited clinical gains and chronic nature of the conditions in older patients was also ranked highly as a stressor. CONCLUSIONS: Working with the elderly is a substantial part of podiatric medical practice and, as such, needs to be seen with a more positive attitude by many practitioners. The development of geriatric practice as a speciality within the profession may help raise the value of working with the elderly. This has implications for preparing podiatric physicians for practice with the geriatric population along with the need for strategies to avoid or minimize these work stressors.

Occupational Stress Among Australian Podiatric Physicians in General and Geriatric Practice.

BACKGROUND: High levels of occupational stress have been reported in podiatrists practising in Australia. One possible stressor is the predominance of the treatment of aged patients with chronic disease in Podiatry practice. METHODS:Forty (40) Podiatrists attending a regional podiatry conference were invited to participate in the research using a convenience sampling method. Podiatrists were asked to complete a survey examining occupational stress in general and specifically in relation to practice with older adults (defined as those over the age of sixty five). RESULTS:The survey of sources of occupational stress among podiatrists has identified that patient demands and expectations are the most significant stressor both in general and in geriatric practice for the Podiatrist. The perceived limited clinical gains and chronic nature of their conditions in older patients was also ranked highly as a stressor. CONCLUSIONS:Working with the elderly is a significant part of podiatry practice and as such needs to be seen with more positive attitude by many practitioners. The development of geriatric practice as a speciality within the profession may help to raise the value of working with the elderly. This has implications for preparing podiatrists for practice with the geriatric population along with the need for strategies to avoid or minimise these work stressors.

Clinical and dynamic range-of-motion techniques in subjects with and without diabetes mellitus.

Thirty subjects with type 1 diabetes, 30 subjects with type 2 diabetes, and 30 age- and sex-matched controls were evaluated through clinical goniometry and two-dimensional motion analysis systems to determine the dynamic and static range of motion of the knee, ankle, and hallux joints. The purpose of this study was to determine if the knee and ankle joints of patients with diabetes mellitus are affected by limited joint mobility syndrome. The study results support previous medical literature showing significant reduction of range of motion of the hallux in subjects with type 1 diabetes. Significant differences were found between the range of motion of male and female subjects in all lower-limb joints for both subject groups with diabetes compared to the control group, and male subjects in all groups recorded less range of motion than female subjects.

Burnout and occupational stress: comparison between United Kingdom and Australian podiatrists.

Professional and occupational burnout is a recognized syndrome among healthcare professionals, although the point at which burnout begins is unclear. There is a dearth of research investigating burnout and occupational stress in relation to podiatric medicine, although two recent studies have reported high levels of burnout expressed by podiatric medical practitioners. This study was undertaken to compare the levels of burnout in newly qualified practitioners in Australia and the United Kingdom. The results suggest that levels of burnout are higher in these groups than indicated by the published normative medical data. Occupational stress was associated with lack of professional status and with geographic and professional isolation. Within these two themes, there were clear differences between the two groups.

Plantar pressure and joint motion after the Youngswick procedure for hallux limitus.

The effects of the Youngswick osteotomy on plantar peak pressure distribution in the forefoot are presented for 17 patients (23 feet) with mild-to-moderate hallux limitus deformity and 23 control subjects (23 feet). During 2 years of follow-up, the operation produced a significant increase in the range of dorsiflexion of the first metatarsophalangeal joint in these patients, reaching near-normal values. Preoperative and postoperative measurements, using a pressure-distribution measurement system, show that peak pressure beneath the hallux and the first metatarsal head remained unchanged. However, peak pressure was significantly increased beneath the second metatarsal head and decreased beneath the fifth metatarsal head. These findings suggest that the foot functioned in a less inverted manner postoperatively. Compared with normal feet, hallux limitus feet demonstrated significantly higher peak pressure beneath the fourth metatarsal head preoperatively and postoperatively.

Idiopathic toe-walking: have we progressed in our knowledge of the causality and treatment of this gait type?

BACKGROUND: Idiopathic toe-walking (ITW) is a condition commonly seen by podiatric physicians. Because a toe-walking gait style is also caused by or associated with many other medical conditions, podiatric physicians should pay particular attention to ensuring an accurate diagnosis. There are many reported treatment options available for ITW. Therefore, a literature review was conducted to determine what treatment options are supported by the evidence as having the best long-term effect on ITW gait. METHODS: After extraction of relevant articles, 21 manuscripts reporting treatment options for ITW gait were appraised against the levels of evidence. RESULTS: From these articles, there was no single treatment option reported as having a long-term effect on the gait of children with ITW. There was support in the literature for surgical interventions, serial casting, and the use of botulinum toxin type A. There was limited evidence that footwear or orthoses changed the gait pattern. CONCLUSIONS: This review updates the knowledge of podiatric physicians, enhances how children who present with this gait style can be managed, and highlights areas for future research.

Contaminants in human nail dust: an occupational hazard in podiatry?

BACKGROUND: There has been limited literature indicating that podiatrists' health may be at risk from exposure to human nail dust. Previous studies carried out in the UK have shown that large amounts of dust become airborne during the human nail drilling procedure and are present in the air up to 10 hours after a clinical session. This increases the risk of Respiratory Tract (RT) infection for the practitioner. METHODS: This study used a nasal swabbing technique and fungal culture to determine whether podiatrists (n = 50) had the same microbes present in their nasal cavities as non-podiatry health professional control group (n = 45). All swabs were cultured, counted and identified for each subject. Survey data of use and type of nail drill, type of mask used and frequency of change over a two week period. RESULTS: The results showed podiatrists had a greater range of microbes in their nasal cavities although the controls had greater overall numbers of organisms. The known pathogen and common mould, Aspergillus fumigatus was ost commonly found fungus within the podiatric group with 44% of the group having the fungus present. All nail drills used by the podiatrists had some form of dust extraction (except one). Of concern was 17% (n = 8) of the podiatrists did not use a mask at all whilst drilling and seemed unaware of any infection control issues. Simple disposable masks were the most frequently worn with only half being changed after each patient further increasing the cross infection risk CONCLUSION: The high levels of Aspergilus contamination is a significant finding in the podiatry group as this fungus is small enough to enter the tissue of the nasal cavity and as a small particle will stay airborne in the room for up to 16 hours. Aspergilus has been shown to cause brain and soft tissue tumours in extreme cases. The high levels of upper respiratory track problems reported in the literature may well be caused by this fungal agent. The non use and use of inappropriate masks by podiatrists is clearly an occupational hazard to their health and well being.

Is idiopathic toe walking really idiopathic? The motor skills and sensory processing abilities associated with idiopathic toe walking gait.

This study aimed to investigate any differences between the motor skills and sensory processing abilities of children between the ages of 4 and 8, who do and do not have an idiopathic toe walking gait. Children in each cohort were tested with a number of norm referenced assessments. A total of 60 children participated, 30 within each cohort. Those with an idiopathic toe walking gait were found to have different Sensory Profile quadrant scores (P = .002), poorer performance on the Bruininks-Oseretsky Test of Motor Proficiency (P ≤ .001), a lower vibration perception threshold (P = .001), and poorer performance on the Standing Walking Balance subtest of the Sensory Integration and Praxis Test (P = .047), compared with non-toe walking peers. Although this research does not give a causative factor for toe walking gait, it provides a number of theories as to why this gait may not be idiopathic in nature.

Erythrocyte aggregation and metabolic syndrome.

Erythrocyte aggregation has been consistently associated with insulin resistance, central obesity and hypertension in the literature. Oxidative stress and chronic inflammation are almost always present in metabolic syndrome (MetS). Prooxidants and adipocytokines generated in MetS alter erythrocyte morphology, decrease erythrocyte deformability and increase whole blood viscosity (WBV). Increased WBV has been attributed to erythrocyte aggregation which in turn is greatly influenced by other rheological parameters, including its membrane surface charge and plasma fibrinogen concentration. The interplay of hemorheological factors, oxidative stress and inflammation has a detrimental effect in MetS due to the gross disturbance in microcirculation. The hemodynamic aspect of MetS needs further research and exploration.

Foot and ankle characteristics of children with an idiopathic toe-walking gait.

BACKGROUND: Idiopathic toe-walking (ITW) in children has been associated with ankle equinus. Although equinus has been linked to foot deformity in adults, there has been limited investigation of the impact of equinus on structural foot change in children. We used the weightbearing lunge test and the six-item version of the Foot Posture Index (FPI-6) to evaluate the weightbearing foot and ankle measures of children with an ITW gait and to compare these with their age-matched peers. METHODS: Sixty 4-to 6-year-old children were grouped into ITW (n = 30) and non-toe-walking (n = 30) cohorts using a validated ITW tool. Ankle range of motion was determined with weightbearing lunge tests. The FPI-6 was calculated during weightbearing stance. RESULTS: There was a highly significant difference in the weightbearing lunge test measures between the ITW cohort and the non-toe-walking cohort. The FPI-6 comparison was not significant. The straight-leg lunge test had a statistically significant relationship with the FPI-6 in the ITW cohort. CONCLUSION: Children with an ITW gait demonstrated reduced flexibility at the ankle joint but similar weightbearing foot posture compared with non-toe-walking children, showing that for children 4 to 8 years old, an ITW gait affects the available ankle dorsiflexion but seems to have a limited effect on weightbearing foot posture as measured by the FPI-6.

Vibration perception thresholds in children with idiopathic toe walking gait.

This study investigated the vibration perception differences between children with an idiopathic toe walking gait and their non-toe walking peers. Sixty children, between the ages of four and eight years, were grouped into an idiopathic toe walking group and non-toe walking group. Vibration perception threshold was assessed at the right hallux. A highly significant difference in the vibration perception threshold between the groups was determined. The idiopathic toe walking group demonstrated a lower vibration perception threshold (P = .001), indicating this group was highly sensitive to vibration input. This change in vibration perception could be symptomatic of physiological changes in the localized receptors within the skin or at a neural perception level. Heightened sensitivity to touch has not yet been explored with children who have an idiopathic toe walking gait. This finding could assist in understanding this gait pattern and allow further research into improved treatment options.

The Toe Walking Tool: a novel method for assessing idiopathic toe walking children.

BACKGROUND: The diagnosis of idiopathic toe walking (ITW) is achieved by the exclusion of all medical causes associated with toe walking. In order to identify children with this gait type, an online Toe Walking Tool questionnaire was developed that utilized questions to identify healthy idiopathic toe walkers and excluded those who toe walk as a result of a medical condition. METHOD: A Delphi panel process was conducted to establish the relevance and validity of the questions. A group of 10 allied health professionals assessed 12 children utilizing the Toe Walking Tool. A kappa was calculated to determine reliability. RESULTS: Clinicians agreed the questionnaire was an appropriate and effective assessment tool. The tool proved valid in that no child tested who toe walked as a result of a medical condition was able to progress through the testing process. Testing group of practitioners had a Fleiss Kappa agreement of 0.928. CONCLUSION: The Toe Walking Tool is a valid and reliable method of assessing children who present to the general allied health clinician with toe walking. This tool can assist with the decision of when to refer a child for further specialist investigation of their toe walking.