Nicoletta Frescos

Prevalence of risk factors for foot ulceration in patients with end‐stage renal disease on haemodialysis

Background:  End‐stage renal disease (ESRD) has been associated with foot ulceration and lower extremity amputation (LEA). However, the underlying risk factors for foot ulceration have received limited attention in this population.

A survey of foot problems in community-dwelling older Greek Australians

BackgroundFoot problems are common in older people and are associated with impaired mobility and quality of life. However, the characteristics of foot problems in older Australians for whom English is a second language have not been evaluated.MethodsOne hundred and four community-dwelling people aged 64 to 90 years with disabling foot pain (according to the case definition of the Manchester Foot Pain and Disability Index, or MFPDI) were recruited from four Greek elderly citizens clubs in Melbourne, Australia. All participants completed a Greek language questionnaire consisting of general medical history, the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire, the MFPDI, and specific questions relating to foot problems and podiatry service utilisation. In addition, all participants underwent a brief clinical foot assessment.ResultsThe MFPDI score ranged from 1 to 30 (median 14), out of a total possible score of 34. Women had significantly higher total MFPDI scores and MFPDI subscale scores. The MFPDI total score and subscale scores were significantly associated with most of the SF-36 subscale scores. The most commonly reported foot problem was difficulty finding comfortable shoes (38%), and the most commonly observed foot problem was the presence of hyperkeratotic lesions (29%). Only 13% of participants were currently receiving podiatry treatment, and 40% stated that they required more help looking after their feet. Those who reported difficulty finding comfortable shoes were more likely to be female, and those who required more help looking after their feet were more likely to be living alone and have osteoarthritis in their knees or back.ConclusionsFoot problems appear to be common in older Greek Australians, have a greater impact on women, and are associated with reduced health-related quality of life. These findings are broadly similar to previous studies in English-speaking older people in Australia. However, only a small proportion of this sample was currently receiving podiatry treatment, and a substantial number stated that they required more help looking after their feet. To address this issue, steps need to be taken to increase awareness of podiatry services among older Greek Australians.

Development and validation of a Greek language version of the Manchester Foot Pain and Disability Index.

BackgroundThe Manchester Foot Pain and Disability Index (MFPDI) is a 19 item questionnaire used to assess the severity and impact of foot pain. The aim of this study was to develop a Greek-language version of the MFPDI and to assess the instruments psychometric properties.MethodsThe MFPDI was translated into Greek by three bilingual content experts and two bilingual language experts, and then back-translated into English to assess for equivalence. The final Greek version was administered, along with a questionnaire consisting medical history and the Medical Outcomes Study Short Form 36 (SF-36), to 104 Greek-speaking, community-dwelling people (64 female, 40 male), aged between 64 and 90 years (mean 73.00, SD 5.26) with disabling foot pain.ResultsThe Greek translation of the MFPDI was found to have high internal consistency (Cronbachs α= 0.89, and item-total correlation coefficients from 0.33 to 0.72). Principal components analysis revealed a four-factor structure representing the constructs of functional limitation, pain intensity, concern with appearance and activity restriction, which explained 60.8% of the variance, with 38.9% of the variance explained by the first construct (functional limitation). Six items demonstrated different factor loadings to the original English version.ConclusionThe Greek-language version of the MFPDI appears to be a valid tool in assessing foot pain in Greek-speaking older people. The total MFPDI scores are comparable between the Greek and English version, however due to differences in the factor loadings of some items, between-language comparisons of MFPDI should be undertaken with some caution.

Effectiveness of Off-the-Shelf, Extra-Depth Footwear in Reducing Foot Pain in Older People: A Randomized Controlled Trial

BACKGROUND Foot pain is highly prevalent in older people and in many cases is associated with inappropriate footwear. This study evaluated the effectiveness of off-the-shelf, extra-depth footwear in reducing foot pain. METHODS Community-dwelling older people with disabling foot pain (72 men and 48 women aged 65 to 96 years; mean age 82 [SD 8]) were randomly allocated to an intervention group (n = 59) or control group (n = 61). The intervention group was provided with off-the-shelf, extra-depth footwear. Participants in the control group received their footwear at the completion of the study. Both groups continued to receive usual podiatry care for the study period. The primary outcome measure was the Foot Health Status Questionnaire (FHSQ), measured at baseline and 16 weeks. RESULTS There was a significant improvement in the FHSQ pain domain (ANCOVA-adjusted mean difference 11.5 points, 95% confidence interval 4.2 to 18.8, p = .002) and FHSQ function domain (10.0 points, 0.9 to 19.1, p = .032) in the intervention group compared to the control group. The intervention group also developed fewer keratotic lesions (mean difference -1.4, -2.5 to -0.2, p = .021), were less likely to report the use of co-interventions (relative risk [RR] 0.74, 0.56 to 0.98, p = .026) and were more likely to report that their foot pain had moderately or markedly improved during the study (RR = 7.93, 2.51 to 25.00, p < .001; number needed to treat = 3, 2 to 5). CONCLUSIONS Off-the-shelf, extra-depth footwear significantly reduces foot pain, improves foot function and is associated with the development of fewer keratotic lesions in older people.

Comparison of the responsiveness of the Foot Health Status Questionnaire and the Manchester Foot Pain and Disability Index in older people

BackgroundIn recent years, several questionnaires have been developed for the assessment of foot health and its impact on quality of life. In order for these tools to be useful outcome measures in clinical trials, their ability to detect change over time (responsiveness) needs to be determined. Therefore, the aim of this study was to assess the responsiveness of two commonly-used questionnaires in older people with foot pain.MethodsParticipants (n = 59; 24 women and 35 men, mean age [SD] 82.3 [7.8] years) allocated to the intervention arm of a randomised controlled trial assessing the effectiveness of extra-depth footwear compared to usual care completed the Foot Health Status Questionnaire (FHSQ) and Manchester Foot Pain and Disability Index (MFPDI) at baseline and 16 weeks. Responsiveness of the FHSQ subscales (pain, function, footwear and general foot health) and MFPDI subscales (pain, functional limitation and concern about appearance) was determined using (i) paired t-tests, (ii) Cohens d, (iii) the standardised response mean (SRM), and (iv) the Guyatt index.ResultsOverall, the FHSQ pain subscale exhibited the highest responsiveness, as evidenced by a highly significant paired t-test (p <0.001), Cohens d = 0.63 (medium effect size), SRM = 0.50 (medium effect size) and Guyatt index = 1.70 (huge effect size). The next most responsive measure was the FHSQ function subscale, as evidenced by a borderline paired t-test (p = 0.050), Cohens d = 0.37 (small effect size), SRM = 0.26 (small effect size) and GI = 1.22 (very large effect size). The FHSQ footwear, FHSQ general foot health and MFPDI pain, functional limitation and concern about appearance subscales demonstrated lower responsiveness, with negligible to medium effect sizes.ConclusionThe FHSQ pain and function subscales were most responsive to change in older people with foot pain receiving a footwear intervention. These findings provide useful information to guide researchers in selecting appropriate outcome measures for use in future clinical trials of foot disorders.

Effectiveness of off-the-shelf footwear in reducing foot pain in Australian Department of Veterans’ Affairs recipients not eligible for medical grade footwear: study protocol for a randomized controlled trial

BackgroundFoot pain is highly prevalent in older people, and in many cases is associated with wearing inadequate footwear. In Australia, the Department of Veterans’ Affairs (DVA) covers the costs of medical grade footwear for veterans who have severe foot deformity. However, there is a high demand for footwear by veterans with foot pain who do not meet this eligibility criterion. Therefore, this article describes the design of a randomized controlled trial to evaluate the effectiveness of low cost, off-the-shelf footwear in reducing foot pain in DVA recipients who are currently not eligible for medical grade footwear.MethodsOne hundred and twenty DVA clients with disabling foot pain residing in Melbourne, Australia, who are not eligible for medical grade footwear will be recruited from the DVA database, and will be randomly allocated to an intervention group or a ‘usual care’ control group. The intervention group will continue to receive their usual DVA-subsidized podiatry care in addition to being provided with low-cost, supportive footwear (Dr Comfort®, Vasyli Medical, Labrador, Queensland, Australia). The control group will also continue to receive DVA-subsidized podiatry care, but will not be provided with the footwear until the completion of the study. The primary outcome measure will be pain subscale on the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8, 12 and 16 weeks. Secondary outcome measures measured at baseline and 16 weeks will include the function subscale of the FHSQ, the Manchester Foot Pain and Disability Index, the number of DVA podiatry treatments required during the study period, general health-related quality of life (using the Short Form 12® Version 2.0), the number of falls experienced during the follow-up period, the Timed Up and Go test, the presence of hyperkeratotic lesions (corns and calluses), the number of participants using co-interventions to relieve foot pain, and participants’ perception of overall treatment effect. Data will be analyzed using the intention-to-treat principle.DiscussionThis study is the first randomized controlled trial to evaluate the effectiveness of off-the-shelf footwear in reducing foot pain in DVA recipients. The intervention has been pragmatically designed to ensure that the study findings can be implemented into policy and clinical practice if found to be effective.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12612000322831

Assessment of pain in chronic wounds: A survey of Australian health care practitioners

Pain associated with chronic wounds can delay wound healing, affects quality of life, and has a major impact on physical, emotional, and cognitive function. However, wound‐related pain is often under‐assessed and may therefore be suboptimally managed. The aim of this study was to describe the assessment practices used to assess chronic wound pain by health practitioners in Australia. A structured self‐administered questionnaire was posted to members of an Australian national wound care organisation, whose membership represents various health practitioners involved in wound management. A total of 1190 (53%) members completed the survey. Overall, wound pain assessment was most commonly conducted at every consultation or wound dressing change (n = 718/1173, 61%). Nurses were more likely to assess wound‐related pain before, during, and after the wound dressing procedures compared with other health care practitioners. In contrast, podiatrists assessed wound pain only when the patient complained about the pain. The most common assessment method was simply talking to the patient (n = 1005/1180, 85%). Two‐thirds of practitioners used a validated pain assessment tool. The most commonly used tool was the numerical analogue scale (n = 524/1175, 46%). In summary, these findings suggest that there is no consistent method for the assessment of wound‐related pain, and there are substantial variations in how and when wound‐related pain is assessed between different professions.

Correction: A survey of foot problems in community-dwelling older Greek Australians.

Since the publication of our Research article [1], the copyright of the Manchester Foot Pain and Disability Index (MFPDI) now states a licence agreement is required for publication. As a result, Additional file 2 has been removed, the English language version of the MFPDI can be found through the ISIS Outcomes website [2].

Assessment and management of pain in chronic wounds: a national survey of Australian health care practitioners caring for people with chronic wounds

Background Pain is one of the key characteristics which distress patients with chronic wounds. Chronic wound pain has a significant impact on the patient’s quality of life and delays wound healing. Assessment and management of pain during wound dressing changes is well addressed, however, chronic persistent wound pain is underassessed and under-treated resulting in patients’ perception that wound pain is something they have to suffer or manage themselves. The purpose of this study was to investigate wound practitioners assessment of chronic persistent wound pain. It sought to identify what assessment tools are utilised in determining the level of pain, the frequency of assessment and how the pain is managed.

The prevalence of risk factors for foot ulceration in patients with end stage renal disease on haemodialysis

Background End stage renal disease (ESRD) has been associated with foot ulceration and lower extremity amputation (LEA). However, the underlying risk factors for foot ulceration have received limited attention in this population. The aim of this study was to investigate the prevalence and type of risk factors for foot ulceration present in patients with ESRD on haemodialysis without the coexistence of diabetes mellitus (DM).