Search Results (16)

Aims: The purpose of this study was to clarify the prevalence of diabetic foot lesions and their association with lower-limb amputations and/or foot ulcers. Materials and Methods: In this cross-sectional study, 968 patients with diabetes were surveyed. Diabetic foot lesions were defined according to the broad national criteria, which encompass both mild abnormalities and more advanced conditions. Based on this definition, foot lesions were assessed using a questionnaire comprising the following 10 items: a history of lower-limb amputations, a history of treatment of foot lesions, numbness/loss of sensation/pain, skin discolorations, skin symptoms, nail abnormalities, foot ulcers/gangrene, foot deformities, foot infection, and intermittent claudication. Logistic regression analysis was used to examine risk factors for foot lesions. Area under the curve (AUC) of the number of foot lesions for lower-limb amputations or foot ulcers/gangrene was calculated using the receiver operating characteristic curve (ROC) analysis. Results: Approximately two-thirds of the patients had at least one type of diabetic foot lesion. Logistic regression analysis revealed that women, past or current smoking, a history of cardiovascular disease, and nephropathy were associated with the risk of diabetic foot lesions. According to the ROC analysis, the optimal cut-off point of number of diabetic foot lesions was three for identifying patients with a history of lower-limb amputation and/or the presence of foot ulcers or gangrene (AUC 0.80 (95% CI, 0.70–0.91), p < 0.01). Conclusions: Diabetic foot lesions are common in patients with diabetes and the prevalence of diabetic foot lesions was higher in patients with a history of lower-limb amputations and/or the presence of foot ulcers or gangrene. Early detection and care of diabetic foot lesions are necessary to prevent lower-limb amputations and foot ulcers. Full article

Objectives: We aimed to explore foot condition and toe strength in older adults undergoing heart valve surgery. Materials and Methods: This exploratory pilot study included nine older adults undergoing heart valve surgery. Subjective data on foot-related symptoms, self-care status, nail care, footwear, exercise habits, and fall history were collected. Preoperative foot and nail conditions were assessed using observation and photography. Toe strength was measured preoperatively in all participants and postoperatively in a subset of participants when feasible. Descriptive analyses were primarily conducted, with exploratory group comparisons. Results: Participants frequently reported foot-related symptoms and difficulties with foot self-care prior to hospitalization. Lower toe strength appeared to be related to greater difficulties in foot self-care, whereas higher toe strength was more commonly observed in those reporting regular exercise habits. Postoperative toe strength was reassessed in six participants. In a participant with prolonged intensive care unit (ICU) stay, delayed recovery of toe strength was observed. Conclusions: These preliminary findings suggest that foot condition and toe strength may be relevant to physical function and fall prevention-related factors in older a dults undergoing cardiac surgery. Reduced toe strength may be related to self-care difficulties, and prolonged ICU stay may influence the recovery of toe strength. However, due to the small sample size, these findings should be interpreted as exploratory and hypothesis-generating. Full article

Superficial fungal infections are common conditions affecting the skin, hair, and nails, primarily caused by dermatophytes, yeasts, and less frequently, molds. Humid climates, prolonged summer seasons, immunodeficiencies, diabetes and socioeconomic factors such as poor hygiene and overcrowding promote them. Children are particularly susceptible due to their immature immune systems and other contributing factors. The infections are classified based on the site involved and include, among others, scalp infections, athlete’s foot, or nail infections (onychomycosis). Scalp mycoses are primarily caused by dermatophytes of the genera Trichophyton and Microsporum, which may originate from human or animal sources. Onychomycosis is rare in young children, with Trichophyton rubrum and Trichophyton mentagrophytes being the most frequently isolated pathogens. The increasing incidence in pediatric populations is linked to atopy, immune disorders, and immunosuppressive therapies. Treatment involves topical and systemic medications, depending on the location and severity of the infection. Maintaining proper hygiene, addressing risk factors, and monitoring therapy are essential to prevent recurrence. Focusing on children, this review explores current epidemiological trends, diagnostic practices, and treatment options related to superficial fungal infections. Full article

Background: An ingrown nail (IN—ingrowing nail) is a very troublesome condition that mainly affects the big toe in all age groups and involves the ingrowth of part of the nail plate into the soft periungual tissues, causing an inflammatory reaction, pain, and even a bacterial infection. As a result of the evolution of inflammation, highly vascularized and painful granulation tissue is formed, visible in the side walls, which causes difficulties in walking, while reducing the quality of life of patients in everyday functioning. The aim of the study was to evaluate the effectiveness of the VHO-Osthold^® Perfect orthonyxic buckle while treating ingrown nails and its effect on the clinical picture of the nail apparatus. Methods: A prospective observational study was conducted on 39 patients with ingrown toenails in Scholz stage 3a–5b who underwent therapy with the use of a VHO-Osthold^® Perfect orthonyxic brace. An original questionnaire form was used to assess the therapy, consisting of several parts concerning the type and stage of the ingrown nails, the location and aetiopathogenesis of the ingrown nails, pain, and the patients’ life quality before and after therapy. Results: All elements improved significantly after treatment (p < 0.05 each). Twelve months after the end of therapy, none of the probands reported disease relapse. The predominant location of ingrown nails was both big toes (69.2% for each foot). The most common group of reasons was outer pressure—all patients experienced at least one issue, with frequent mechanical injuries being the most common (59.0%), followed by wearing too-small shoes (46.2%). Almost half of the patients declared no worries during treatment (48.7%). Life quality assessment grew from 1.82 ± 1.02 to 6.41 ± 0.72 on a scale from 1 to 7, p < 0.001. Conclusions: The VHO-Osthold^® Perfect clamp eliminates pain after application to the ingrown toenail and allows for a safe and conservative approach to the treatment of ingrown toenails, improving the clinical picture of the nail apparatus, general well-being, and the quality of life of patients with advanced ingrown toenails. Full article

Foot disorders in older individuals compromise balance and contribute to postural and gait instabilities, causing a decrease in the activities of daily living and quality of life. In this cross-sectional study, we analyzed the foot-related data of 160 frail older participants who attended day service centers in A prefecture in Japan to determine the prevalence of foot problems and their associations with toe grip strength and walking speed in frail older people. Multiple regression analysis was used to identify foot-related variables that correlated with toe grip strength and walking speed. The prevalence rates of skin dryness (Support level 88.2%, Care level 85.2% for men; Support level 84.9%, Care level 93% for women) and suspected and existing fungal infections in nails (Support level 94.1%, Care level 92.6% for men; Support level 98.1%, Care level 95.2% for women) were high in both sexes regardless of the level of care required. Furthermore, in both sexes, the prevalence rates of toe and arch deformities were significantly increased in the people who required care. Regression analysis revealed that some right-sided foot-related problems were significantly associated with right toe grip strength and walking speed. The decrease in toe grip strength was significantly associated with walking speed. Our study provides evidence that some specific conditions were associated with toe grip force and walking speed. This finding can contribute to future strategies to protect foot health in community-dwelling older individuals. Full article

Onychomycosis is one of the most common foot conditions. Mixed onychomycosis and onychomycosis caused by non-dermatophyte moulds are increasing in incidence, especially in vulnerable populations, hence the importance of this study, which presents the prevalence of onychomycosis in a population of homeless people, comparing the findings with a sample of a well-resourced population. The total sample consisted of 70 participants, divided into two separate groups, a homeless population and a second group in which we included people attending a private clinic. The average age of the sample is [49.19 ± 28.81] with an age range of 18 to 78 years. In the homeless group, the most prevalent infectious agents were non-dermatophyte fungi, with a total of 48%, compared to 28% in the group housed. The most common site of infection in both groups was the nail of the first finger. We, therefore, conclude that there is a difference in the infecting agent in the homeless population and the population with homes. Full article

(1) Background: Onychomycosis (OM) is a fungal nail infection, considered a risk factor for diabetic foot ulcers. It is associated with changes in quality of life, in terms of pain, self-confidence and self-esteem. The aim was to translate and adapt the OM quality of life questionnaire “OnyCOE-t^TM–Quality Of Life Questionnaire Onychomycosis (Nail Fungal Condition)”. (2) Methods: This study followed the guidelines proposed by Beaton et al. (2000), where two English to Portuguese translations were performed and, after an expert consensus, a common version was obtained. This was followed by two back-translations. The expert committee achieved semantic equivalence, idioms and concepts. The pre-test was applied to 49 people. The final version and processed data were sent to the authors. (3) Results: We adapted terms semantically, modified statements syntactically, altering items from interrogative to affirmative. (4) Conclusions: The translated version of the “Quality of life–Onychomycosis” questionnaire suggested that it can be used for further studies to test validity and reliability in this population. Full article

Onychogryphosis is a nail disorder that can damage nail plates, usually caused by repeated minor trauma to the foot. Onychogryphosis of the toe is commonly seen in clinical practice; however, optimal treatment of the condition is still the subject of debate. The purpose of this study was to evaluate clinical outcomes of patients with toe onychogryphosis treated by subcutaneous flap coverage after total matricectomy. In this article, we describe 12 patients who had onychogryphosis on the great toe treated by subcutaneous flap coverage after total matricectomy. There were eight men and four women, with a mean age of 63.8 years (range, 56–74 years). The follow-up period ranged from 4 to 108 months, with an average of 25.2 months. All of the flap reconstructions ultimately survived. The advantage of the described technique is the avoidance of tight closure of the skin and preservation of toe length. The possible limitation of the technique is poor blood circulation to the feet. Full article

Candida albicans is an opportunistic pathogen that often causes skin infections such as oral thrush, nail fungus, athlete’s foot, and diaper rash. Under particular conditions, C. albicans alters the natural balance of the host microbiota, and as a result, the skin or its accessory structures lose their function and appearance. Conventional antimycotic drugs are highly toxic to host tissues, and long-lasting drug administration induces the arising of resistant strains that make the antimycotic therapy ineffective. Among new antimicrobial approaches to combine with traditional drugs, light-based techniques are very promising. In this study, a panel of dyes was considered for photodynamic therapy (PDT) applications to control the growth of the model strain C. albicans ATCC 14053. The chosen photosensitizers (PSs) belong to the family of synthetic porphyrins, and in particular, they are diaryl-porphyrins. Among these, two monocationic PSs were shown to be particularly efficient in killing C. albicans upon irradiation with light at 410 nm, in a light-dose-dependent manner. The elicited photo-oxidative stress induced the loss of the internal cellular architecture and death. The photodynamic treatment was also successful in inhibiting the biofilm formation of clinical C. albicans strains. In conclusion, this study supports the great potential of diaryl-porphyrins in antimicrobial PDT to control the growth of yeasts on body tissues easily reachable by light sources, such as skin and oral cavity. Full article

Background and objectives: Foot lesions can be developed during hiking because of external factors. This makes it important to study the effect of hiking equipment on lesion development. Materials and Methods: Technical and non-technical socks were given to 109 hikers to wear during a short hike. Participants were examined at three stages of the hike to determine the development of dermal, muscle and nail lesions, temperature and perimeter in various areas of each foot. Results: The percentage of hikers without injuries was significantly higher among those wearing technical socks (p-value < 0.001). Differences were also observed in mean foot temperature, which was higher in participants wearing technical socks (p-value < 0.001). Conclusion: The results indicate that even on a low-difficulty, short-term sport activity, it is advisable to wear technical socks to prevent lesion development and keep the foot temperature more stable. Sock type was identified as an external conditioning factor in lesion development. Full article

Cancer is one of the leading causes of mortality and morbidity worldwide. Recent improved therapies have resulted in more patients surviving cancer and living longer. Despite these advances, the majority of patients will develop adverse events from anticancer therapies. Foot alterations, including nail toxicities, hand-foot syndrome, edema, xerosis, hyperkeratosis, and neuropathy, are frequent among cancer patients. These untoward conditions may negatively impact quality of life, and in some cases may result in the interruption or discontinuation of cancer treatments. Appropriate prevention, diagnosis, and management of podiatric adverse events are essential to maintain foot function and health-related quality of life, both of which are critical for the care of cancer patients and survivors. This article shows results related to complaint and impact on quality of life of the Oncology Foot Care program and reviews publications specific to podiatric adverse events related to cancer treatments. Full article

Retronychia, the posterior embedding of the nail bed into the proximal nail fold, can be a complex clinical dermatologic diagnosis that may mimic other inflammatory ungual diseases or tumors of the nail. It has been related to a history of severe systemic conditions that secondarily affect the nail matrix and is commonly associated with onychomadesis. We present a case of retronychia of the foot with a purely traumatic origin, nonconcomitant with onychomadesis, that was diagnosed by color Doppler ultrasound in a long-time practitioner of martial arts who was otherwise healthy. Color Doppler ultrasound is an excellent imaging technique for supporting the diagnosis of retronychia. It provides information on the exact location and morphology of the nail plate as well as the presence of inflammatory signs in the ungual and proximal periungual regions. Additionally, this imaging technique can support the differential diagnosis with other nail conditions. Since there are many sports or activities that can potentially injure the toenails, retronychia may be an underestimated entity and the present case can raise the awareness of this condition and show the usefulness of color Doppler ultrasound. (J Am Podiatr Med Assoc 107(3): 253-256, 2017) Full article

Background: Literature examining the incidence of foot diseases in rock climbing is limited to traumatic injuries. We examined a large sample of climbers, assessed the chronic diseases of the foot, and correlated them with foot morphology, shoe type, and type of climbing practiced. Methods: Between May 1 and September 30, 2009, 144 climbers (mean age, 31.7 years) were examined to analyze the effect of rock climbing on the various foot diseases found at the time of the evaluation. Results: Eighty-six percent of the climbers were affected by a pathologic condition. Nail disease was found in 65.3% of patients, followed by recurrent ankle sprains (27.8%), retrocalcaneal bursitis (19.4%), Achilles tendinitis (12.5%), metatarsalgia (12.5%), and plantar fasciitis (5.6%). Male sex, the use of high-type shoes, the high degree of climbing difficulty, and the competitive level were often related to the onset of foot diseases. Climbing shoes are usually smaller than common footwear. This ‘‘shoe-size reduction’’ averaged 2.3 sizes, forcing the foot into a supinated and cavus posture that favors lateral instability. The posterior edge of the shoe aperture produces increased pressure on the heel, with retrocalcaneal bursitis. Conclusions: Overuse foot diseases related to rock climbing are particularly frequent and debilitating. Detailed knowledge of these diseases and their predisposing factors may help us implement effective preventive or therapeutic measures, including changes in the type of climbing, correction of body weight, degree of difficulty, footwear, orthoses, and measures that maximize the support of the foot to the ground. (J Am Podiatr Med Assoc 103(2): 113-120, 2013) Full article

Severely incurved toenails are accompanied by deformity of the toenail growth plate. In such a condition, partial removal of the nail and nail bed and simple unfolding of the nail itself frequently result in the recurrence of symptoms. We sought to design and develop a new technique for the treatment of incurved toenail with growth plate deformity and to report the results of treating this disease entity. Forty consecutive patients (52 cases) underwent treatment of symptomatic incurved toenails with a new technique named matrixplasty. The mean ± SD patient age was 40.3 ± 18.9 years. Last follow-up was at a mean ± SD of 18.0 ± 1.3 months. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned, and patients were evaluated before treatment and at last follow-up. Patient satisfaction and the recurrence rate of the deformity were evaluated. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured before treatment and at last follow-up. The complication rate was also evaluated. All of the ingrown toenails healed, and the nail deformities were corrected within 3 weeks after the procedure. None of the incurved toenails had recurred by last follow-up. The mean pretreatment AOFAS forefoot hallux score was 72.9, and it improved to 99.6 by last follow-up (P < .001). Every patient was very satisfied or satisfied with the results of treatment. The mean ± SD center to edge angle of the toenail improved from 53.3° ± 9.5° to 15.3° ± 5.2° by last follow-up (P < .001). Minor paronychia, which was managed with local wound dressing and oral antibiotics, was identified in four cases. No other complication was identified. Matrixplasty showed excellent clinical results in the treatment of severe incurved toenail, and this newly developed procedure showed improvement of the deformed toenail and its growth plate. (J Am Podiatr Med Assoc 102(3): 198–204, 2012) Full article

Subungual exostosis is a slow-growing, benign outgrowth of normal bone under the nail that affects the nail unit. The most common location in the foot is the dorsal surface of the distal phalanx of the big toe. Clinically, it can appear in combination with a variety of nail disorders, masking the underlying bone condition, which is frequently unrecognized or misdiagnosed. A new classification system for these lesions is proposed on the basis of the clinical signs and symptoms present during examination and the associated disorders of the nail plate. Also, a therapeutic algorithm that describes surgical approaches to the different presentations of this disorder is presented. (J Am Podiatr Med Assoc 99(6): 519-524, 2009) Full article