Search Results (290)

Superficial fungal infections of the feet, such as tinea pedis and onychomycosis, are highly prevalent and frequently recurrent, often due to persistent contamination of footwear, textiles, and foot care instruments. Despite growing concern over antifungal resistance, environmental sources of reinfection remain under-recognized in clinical practice. This review critically examines historical and contemporary methods used to sanitize shoes, socks, podiatric tools, and related materials. Evidence from peer-reviewed studies published between 1938 and 2025 was analyzed across multiple disinfection categories, including chemical agents, thermal methods, laundering, ultraviolet- and ozone-based technologies, antimicrobial textiles, and sterilization protocols. Findings reveal a range of efficacies, limitations, and practical considerations across methods, with steam sterilization emerging as the most reliable for reusable instruments. A multifaceted approach combining pharmacologic treatment with consistent environmental hygiene is essential for breaking reinfection cycles and reducing antifungal resistance. This review highlights the need for clinical education and research into scalable, effective disinfection strategies. Full article

Background: Diabetic foot ulcers (DFUs) are a serious complication of diabetes and are often difficult to treat. Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive treatment to promote healing, but its long-term clinical and biological effects remain insufficiently characterized. This study aimed to evaluate the impact of HBOT on systemic biomarkers, local microvasculature, and clinical outcomes in patients with DFUs. Methods: In this non-randomized prospective study, 20 patients with ischemic DFUs were followed over a 36-month period. Fourteen received HBOT in addition to standard care, while six received standard care alone. Clinical outcomes—including DFU resolution, recurrence, lower extremity amputation (LEA), and mortality—were assessed alongside systemic inflammatory and angiogenic biomarkers and wound characteristics at baseline and at 3, 6, 12, and 36 months. CD31 immunostaining was performed on available tissue samples. Results: The two groups were comparable at baseline (mean age 62 ± 12 years; diabetes duration 18 ± 9 years). At 3 months, the HBOT group showed significant reductions in erythrocyte sedimentation rate and DFU size (p < 0.05), with downward trends observed in C-reactive protein (CRP), vascular endothelial growth factor (VEGF), and placental growth factor (PlGF), and an increase in stromal-derived factor-1 alpha (SDF1-α). No significant changes were observed in the control group. CD31+ microvessel density appeared to increase in HBOT-treated DFU tissue after one month, although the sample size was limited. Patients receiving HBOT had lower rates of LEA and mortality, improved wound healing, and sustained outcomes over three years. DFU recurrence rates were similar between groups. Conclusions: HBOT was associated with improved wound healing and favorable biomarker profiles in patients with treatment-resistant ischemic DFUs. While these findings are encouraging, the small sample size and non-randomized design limit their generalizability, highlighting the need for larger, controlled studies. Full article

Objective: To develop and validate a ResNet-50-based deep learning model for automatic detection of osteomyelitis (DFO) in plain radiographs of patients with diabetic foot ulcers (DFUs). Research Design and Methods: This retrospective study included 168 patients with type one or type two diabetes and clinical suspicion of DFO confirmed via a surgical bone biopsy. An experienced clinician and a pretrained ResNet-50 model independently interpreted the radiographs. The model was developed using Python-based frameworks with ChatGPT assistance for coding. The diagnostic performance was assessed against the histopathological findings, calculating sensitivity, specificity, the positive predictive value (PPV), the negative predictive value (NPV), and the likelihood ratios. Agreement between the AI model and the clinician was evaluated using Cohen’s kappa coefficient. Results: The AI model demonstrated high sensitivity (92.8%) and PPV (0.97), but low-level specificity (4.4%). The clinician showed 90.2% sensitivity and 37.8% specificity. The Cohen’s kappa coefficient between the AI model and the clinician was −0.105 (p = 0.117), indicating weak agreement. Both the methods tended to classify many cases as DFO-positive, with 81.5% agreement in the positive cases. Conclusions: This study demonstrates the potential of IA to support the radiographic diagnosis of DFO using a ResNet-50-based deep learning model. AI-assisted radiographic interpretation could enhance early DFO detection, particularly in high-prevalence settings. However, further validation is necessary to improve its specificity and assess its utility in primary care. Full article

Diabetic foot ulcers (DFUs) are a serious complication of diabetes, associated with high recurrence and amputation rates. Adherence to offloading devices is critical for wound healing but remains inadequately monitored in real-world settings. This study evaluates the SmartBoot edge-computing system—a wearable, real-time remote monitoring solution integrating an inertial measurement unit (Sensoria Core) and smartwatch—for its validity in quantifying cadence and step count as digital biomarkers of frailty, and for detecting adherence. Twelve healthy adults wore two types of removable offloading boots (Össur and Foot Defender) during walking tasks at varied speeds; system outputs were validated against a gold-standard wearable and compared with staff-recorded adherence logs. Additionally, user experience was assessed using the Technology Acceptance Model (TAM) in healthy participants (n = 12) and patients with DFU (n = 81). The SmartBoot demonstrated high accuracy in cadence and step count across conditions (bias < 5.5%), with an adherence detection accuracy of 96% (Össur) and 97% (Foot Defender). TAM results indicated strong user acceptance and perceived ease of use across both cohorts. These findings support the SmartBoot system’s potential as a valid, scalable solution for real-time remote monitoring of adherence and mobility in DFU management. Further clinical validation in ongoing studies involving DFU patients is underway. Full article

Exercise is a cornerstone of diabetes management, but the onset of diabetic foot disease (DFD) can significantly limit its implementation. Meanwhile, physical activity (PA) has been shown to reduce the risk of developing DFD through various mechanisms, and emerging evidence also supports the role of exercise in managing the active phase of the condition. Appropriately tailored PA offers both local and systemic benefits—even in clinical contexts where foot offloading is recommended. The research indicates that selected exercises can be safely incorporated into care plans, providing therapeutic effects without compromising wound healing. Drawing from current knowledge based on basic science, clinical research, and relatively general recommendations, this article summarizes the local and systemic effects of properly selected exercises in patients with DFD. It explains the underlying mechanisms and briefly discusses practical examples, integrating the most recently published findings. Full article

Background: Diabetic foot disease is a public health problem. The challenges of its management lie in the complexity of wound healing and, in particular, the high rate of lesion recurrence. Objectives: The primary objective of the study was to evaluate whether optimized post-healing follow-up by a multidisciplinary team can reduce the recurrence rate of foot ulcers in people living with diabetes. The secondary objectives were to assess patient needs in terms of hospitalization for recurrence, the number of amputations, pedicure care, and the use of adapted footwear. Participants: The study included 129 patients with diabetes presenting a healed foot ulcer. A total of 38 patients underwent an annual post-healing follow-up visit with a multidisciplinary team (optimized follow-up), while 91 had a visit every 2 years (minimum follow-up). Results: Of the 38 patients with optimal follow-up, 8 presented a wound recurrence (21.1%) compared with 38 out of 91 patients (41.8%) receiving minimum follow-up. The recurrence rate decreased significantly between the two groups (p < 0.05). The use of adapted shoes was also significantly better in the group with optimized follow-up (p = 0.02). Conclusions: Regular post-healing follow-up with a multidisciplinary team seems to be a contributing factor to reducing the recurrence of diabetic foot ulcers among people living with diabetes. Full article

Plantar pressure monitoring is decisive in injury prevention, especially in at-risk populations such as people with diabetic foot. In this context, innovative solutions such as pneumatic insoles can be essential in plantar pressure management. This study describes the development of a variable pressure system that promotes the monitoring, stabilization, and offloading of plantar pressure through a pneumatic insole. This research was also intended to evaluate its ability to redistribute plantar pressure, reduce peak pressure in both static and dynamic conditions, and validate its pressure measurements by comparing the results with those obtained from a pedar^® insole. Tests were carried out under both static and dynamic conditions, before and after the pressure stabilization process by air cells and the subsequent pressure offloading. During the validation process, methods were used to evaluate the agreement between measurements obtained by the two systems. The results of the static test showed that pressure stabilization reduced pressure on the heel by 32.43%, distributing it to the metatarsals and toes. After heel pressure offloading, the reduction reached 42.72%. In the dynamic test, despite natural dispersion of the measurements, a trend to reduce the peak pressure in the heel, metatarsals, and toes was observed. Agreement analysis recorded 96.32% in the static test and 94.02% in the dynamic test. The pneumatic insole proved effective in redistributing and reducing plantar pressure, with more evident effects in the static test. Its agreement with the pedar^® system reinforces its reliability as a tool for measuring and managing plantar pressure, representing a promising solution for preventing plantar lesions. Full article

Diabetic foot ulcers (DFUs) constitute a severe and debilitating complication of diabetes, imposing a substantial global health burden due to their intricate pathophysiology and impaired wound healing processes. Vitamin D deficiency is highly prevalent among diabetic populations, and accumulating evidence indicates its potential involvement in the pathogenesis and prognosis of DFUs. This review comprehensively explores the diverse roles of vitamin D in DFUs, encompassing its molecular mechanisms such as immunomodulation, promotion of angiogenesis, neuroprotection, and induction of antimicrobial peptides, as well as the metabolic characteristics associated with various vitamin D forms and compromised vitamin D receptor (VDR) signaling pathways. Although robust observational studies have established an association between vitamin D deficiency and adverse outcomes in DFUs, the clinical validation of supplementation efficacy through randomized controlled trials (RCTs) remains constrained by limitations such as small sample sizes, heterogeneity in study protocols, and insufficient long-term follow-up. This highlights the critical need for large-scale, high-quality studies to ascertain optimal treatment regimens and to cater to individualized patient requirements, particularly for individuals with obesity or those with renal impairments. Innovative strategies, such as the topical administration of vitamin D through intelligent delivery systems leveraging advanced biomaterials like nanofibers and hydrogels, exhibit substantial preclinical potential in enhancing stability, achieving targeted controlled release, and augmenting local biological effects, including the induction of antimicrobial peptides. Nevertheless, significant challenges persist in conclusively establishing clinical efficacy, comprehensively elucidating the underlying mechanisms, ensuring the safe translation of novel delivery systems, and developing personalized therapeutic strategies. The future success of these interventions hinges on meticulous research and interdisciplinary collaboration to seamlessly integrate validated vitamin D-based interventions into a comprehensive multidisciplinary management framework for DFUs, thereby holding promise for improving the clinical outcomes of this debilitating condition. Full article

Background: Diabetic foot ulcers (DFUs) affect 25% of diabetes patients, with high risks of amputation (70%), recurrence (65% within 3–5 years), and mortality (50–70% at 5-years). Current treatments are limited by persistent inflammation, oxidative stress, and cost barriers. This study evaluates a bioactive dressing combining a natural latex-based (NLB) biomembrane (Hevea brasiliensis) with curcumin-loaded liposomes, exhibiting angiogenic and antimicrobial properties, and red LED (light-emitting diode) phototherapy (635–640 nm) to address these challenges. Methods: A pilot clinical trial randomized 15 DFU participants into three groups: Control (CG, n = 5, standard care); Experimental Group 1 (EG1, n = 5, NLB + LED, daily treatment); and Experimental Group 2 (EG2, n = 5, NLB-curcumin liposomes + LED, daily treatment). Outcomes included wound closure, inflammatory/oxidative markers, and therapy feasibility. Assessments at D0, D22, and D45 included hematological/biochemical profiling, reactive oxygen species (ROS), and wound area measures. Results: On day 45, GE2 showed an average ulcer contraction of 89.8%, while CG showed 32.8%, and GE1 showed 9.7%. Systemic ROS and biomarkers (C-reactive protein, leukocytes) showed no significant changes (p > 0.05), though transient inflammatory spikes occurred. The combined therapy (EG2) accelerated healing without direct biomarker correlations. Conclusions: These findings highlight the potential of this combined therapy as an accessible, cost-effective DFU treatment, warranting larger studies to optimize home-based protocols and elucidate mechanisms. Full article

Background: Type 2 diabetes (T2D) is a chronic disease that significantly impacts individuals’ quality of life, affecting their physical, psychological, social, and environmental well-being. Objectives: This study investigates how self-care habits influence quality of life and key health indicators, such as glycated hemoglobin (HbA1c), blood sugar levels, and body mass index (BMI), among newly diagnosed diabetic individuals in Vlore, Albania. Methods: In this cross-sectional study, 332 individuals recently diagnosed with diabetes were surveyed between April and July 2024. Data were collected using the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and the Summary Diabetes Self-Care Activity (SDSCA) surveys. Sociodemographic and clinical information, including age, education, occupation, duration of diabetes, HbA1c, and BMI, were collected through structured interviews and medical records. Descriptive and multivariate analyses were conducted to examine the relationships between self-care behaviors, sociodemographic factors, and quality of life. Results: The findings reveal a low quality of life, with a mean quality of life (QoL) score of 35.33 ± 8.25. Environmental domains were most affected, registering a low QoL score of 30.93 ± 9.04. Significant relationships between QoL, self-care practices, and sociodemographic factors and pathologic factors were found. The analysis indicated that distinct factors influenced various domains of quality of life. Physical health was associated with residence, comorbidities, BMI, and HbA1c, follow-up visits, dietary self-care and physical activity self-care. Psychological health correlated with residence, educational level, BMI, and HbA1c, follow-up visits, dietary, physical activity and foot self-care. Age, occupation, BMI, and physical activity self-care were linked to social relationships. Finally, environmental well-being was influenced by gender, residence, BMI, HbA1c, follow-up visits, and dietary and physical activity self-care. Conclusions: This study emphasizes the impact of sociodemographic and clinical factors on the quality of life of patients with T2D. Older age, lower education levels, comorbidities, increase in BMI and HbA1c levels, and inadequate self-care were associated with reduced quality of life. These findings highlight the need for targeted interventions and policies that promote self-care and support for at-risk groups. Full article

The recent spread of foreign animal diseases (FADs) such as foot-and-mouth disease and African swine fever emphasizes the need to conduct comprehensive surveillance to detect a potential disease introduction as soon as possible. The United States is currently free of many important FADs of swine, and many preparedness initiatives have raised awareness amongst the commercial, intensive swine industry. However, the awareness and engagement of small-scale swine farmers regarding disease surveillance and passive reporting is not well known. This scoping review was conducted to identify and characterize sources of evidence on the practices and attitudes of small-scale swine farmers and owners in the United States regarding pig health and disease management, surveillance, and veterinary care use, and secondarily to characterize information seeking and communication behaviors. Sources of evidence were found through keyword searches of online databases, citation matching, and Sustainable Agriculture Research and Education project reports. Eligibility criteria included being conducted on or with US small-scale (defined in this review as less than 1000 pigs) or non-intensive swine farms and containing information pertinent to the objectives of the review. Seventeen sources were included in the final review. Regular disease monitoring and surveillance practices were not commonly reported, and multiple sources reported little to no incidence of disease occurrence in small-scale swine farms. Reported veterinary use and access was variable, and multiple sources reported that the choice to use veterinary care was affected by its perceived cost, value, and accessibility. Future research and outreach should aim to discern key factors affecting farmer’s decisions to use a veterinarian, improve their awareness and prioritization of swine diseases, and develop small-scale appropriate disease surveillance protocols. Ultimately, this will help small-scale swine farmers to protect the health of their pigs and improve FAD surveillance in the US. Full article

Photocatalysis and photodynamic therapy have been increasingly used in the management of diabetic foot ulcers (DFUs), and their integration into increasingly innovative treatment protocols enables effective infection control. Advanced techniques such as antibacterial photodynamic therapy (aPDT), liposomal photocatalytic carriers, nanoparticles, and nanomotors—used alone, in combination, or with the addition of antibiotics, lysozyme, or phage enzymes—offer promising solutions for wound treatment. These approaches are particularly effective even in the presence of comorbidities such as angiopathies, neuropathies, and immune system disorders, which are common among diabetic patients. Notably, the use of combination therapies holds great potential for addressing challenges within diabetic foot ulcers, including hypoxia, poor circulation, high glucose levels, increased oxidative stress, and rapid biofilm formation—factors that significantly hinder wound healing in diabetic patients. The integration of modern therapeutic strategies is essential for effective clinical practice, starting with halting infection progression, ensuring its effective eradication, and promoting proper tissue regeneration, especially considering that, according to the WHO, 830 million people worldwide suffer from diabetes. Full article

This study explores the integration of advanced artificial intelligence (AI) techniques with infrared thermography for diagnosing diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD). Diabetes-related foot complications, including DPN and PAD, are leading causes of morbidity and disability worldwide. Traditional diagnostic methods, such as the monofilament test for DPN and ankle–brachial pressure index for PAD, have limitations in sensitivity, highlighting the need for improved solutions. Thermographic imaging, a non-invasive, cost-effective, and reliable tool, captures temperature distributions of the patient plantar surface, enabling the detection of physiological changes linked to these conditions. This study collected thermographic data from diabetic patients and employed convolutional neural networks (CNNs) and vision transformers (ViTs) to classify individuals as healthy or affected by DPN or PAD (not healthy). These neural networks demonstrated superior diagnostic performance, compared to traditional methods (an accuracy of 95.00%, a sensitivity of 100.00%, and a specificity of 90% in the case of the ResNet-50 network). The results underscored the potential of combining thermography with AI to provide scalable, accurate, and patient-friendly diagnostics for diabetic foot care. Future work should focus on expanding datasets and integrating explainability techniques to enhance clinical trust and adoption. Full article

Foot and mouth disease virus (FMDV) is a highly pathogenic virus that mainly infects cloven hooved animals, such as pigs. The establishment of a rapid, sensitive and accurate point-of-care detection method is critical for the timely identification and elimination of infected pigs for controlling this disease. In this study, a RT-RAA-CRISPR/Cas13a method was developed for the detection of FMDV serotype O in pigs. Six pairs of RT-RAA primers were designed based on the conserved gene sequence of FMDV serotype O, and the optimal amplification primers and reaction temperatures were screened. The CRISPR-derived RNA (crRNA) was further designed based on the optimal target band sequence and the most efficient crRNA was screened. The results revealed that FMDV-O-F4/R4 was the optimal primer set, and the optimal temperature for the RT-RAA reaction was 37 °C. Moreover, crRNA4 exhibited the strongest detection signal among the six crRNAs. The established RT-RAA-CRISPR/Cas13a method demonstrated high specificity and no cross-reactivity with other common swine pathogens such as Senecavirus A (SVA), porcine reproductive and respiratory virus (PRRSV), porcine epidemic diarrhea virus (PEDV), porcine circovirus type 2 (PCV2), classical swine fever virus (CSFV), and pseudorabies virus (PRV), additionally, it was observed to be highly sensitive, with a detection limit of 19.1 copies/µL. The repeatability of this method was also observed to be good. This method could produce stable fluorescence and exhibited good repeatability when three independent experiments yielded the same results. A validation test using three types of simulated clinical samples (including swab, tissue, and serum samples) revealed a 100% concordance rate. The detection results could be visualized via a fluorescence reader or lateral flow strips (LFSs). Thus, a highly specific and sensitive RT-RAA-CRISPR/Cas13a detection method was developed and is expected to be applied for the rapid detection of FMDV serotype O in situ. Full article

Background: Continuous Compression Implants (CCIs) are low-profile implants made of nitinol and titanium. They offer multiple benefits in comparison to plate and screw fixation for foot and ankle indications, and they are designed in such a way that they continuously and dynamically compress the opposed bony surfaces throughout the entire healing process. Methods: In this study, we present our experience on the use of those nitinol implants for midfoot and hindfoot surgery. Furthermore, we elaborate on the advantages and downsides of using this internal fixation method and highlight common pitfalls which could lead to undesirable clinical outcomes. We also demonstrate our proposed surgical technique on how to use CCIs in a reproducible and reliable way and present surgical tips which could help reduce surgical time when utilising these implants. We also make surgical recommendations on their use and present the underlying biomechanics, which could provide a better understanding of the rationale behind using them in the field of foot and ankle surgery. Last but not least, we presented the early clinical and radiological results of a series of patients who underwent primary midfoot fusion for Lisfranc injury between 2020 and 2023. Results: With a minimum follow-up of 9 months, satisfactory clinical and radiological union was noted in all those patients. The mean difference between pre- and post-operative MOxFQ scores was −37.7 (95% CI was 16.9 to 58.5; p = 0.03). The mean post-operative VAS pain at rest was 3.2 (SD = 2.3). No major complications were noted. Conclusions: CCI internal fixation is a safe, reproducible, and reliable method when it comes to foot and ankle conditions, but it requires appropriate pre-operative planning, surgical training, and careful implantation. Full article