Degree of burnout among Maltese podiatrists working in two different settings

The issue of burnout is receiving increasing research attention. However, most of the literature on burnout has focused on the nursing, physiotherapy and occupational therapy professions, with very few studies within the podiatric profession exploring this concept. The purpose of this paper is to compare the degree of burnout among Maltese podiatrists working in two different settings, namely the public health service and private practice. A quantitative non-experimental study, involving a convenience sample, was conducted. The Copenhagen Burnout Inventory (CBI) was used to evaluate levels of burnout in the two participant groups. No statistical difference was found between the overall mean burnout scores for Maltese podiatrists employed in the public health service and those working in private practice (p = 0.067, mean = 48.89 vs 31.84). Although the level of burnout did not differ between podiatrists working within the two different settings, podiatrists working in the public sector in general reported higher mean scores for each subscale of the CBI than podiatrists working in private practice. More research is necessary to build a better understanding of burnout among podiatrists in parallel with other health care professionals, in order to help prevent or alleviate this phenomenon.peer-reviewe

Duration of type 2 diabetes is a predictor of elevated plantar foot pressure

AIMS: Elevated plantar pressure is considered a significant risk factor for ulceration in diabetes mellitus. The aim of this study was to determine whether duration of diabetes could affect plantar pressure in patients with no known significant comorbidity or foot pathology.METHODS: Participants with type 2 diabetes, but without known confounding factors that could alter peak pressure, were matched for age, weight, and gender and categorized into 3 groups of diabetes duration: group 1 (1-5 yr), group 2 (6-10 yr), and group 3 (11-15 yr). Plantar pressures were recorded utilizing a twostep protocol at a self-selected speed.RESULTS: One-way analysis of variance (ANOVA) revealed significant differences in mean peak plantar pressures between the three groups under the 2nd - 4th metatarsophalangeal joint (MPJ) region of interest (ROI) (p = 0.012 and p = 0.022, respectively) and left heel (p = 0.049). Also, a significant difference in mean pressure-time integral under the left 2nd - 4th MPJ ROI (p = 0.021) and right heel (p = 0.048) was observed. Regression analysis confirmed that mean peak plantar pressures in the first group (but not in the second group) were significantly lower than in the third group (p = 0.005).CONCLUSIONS: As the duration of diabetes increased, peak plantar pressure increased significantly under the 2nd - 4th MPJ ROIs. These findings suggest that clinicians should make more use of pressure mapping technology as part of their clinical management plan in patients with diabetes >10 yr, even if they have no complications or deformities, to preserve functional limbs in this high-risk population.peer-reviewe

An overview of patient cases which have problems with discharge from Mater Dei Hospital

Patients which have problems for discharge can be commonly found within the confines of Mater Dei Hospital. These patients pose a considerable burden both economically as well as in terms of opportunity cost. The management of these patients is complex and multifaceted. All patient cases residing within the medical wards and had issues preventing discharge from hospital during the months of August and September 2016 were analysed so as to identify common factors between cases. Most patients were between 81-90 years old, female and partially dependent in their Activities of Daily Living. 94% of these cases presented as emergency cases. Interestingly, 52% of all cases were started on psychiatric medication whilst awaiting long term care. The most popular drug which was started in this instance was Haloperidol (Serenace) 0.5mg. Majority of patients and their relatives were unaware of the available supporting services. Hence from this we can recommend that better marketing of available domiciliary services could decrease the problem and more education on psychiatric problems of the elderly especially in institutionalizations would be of benefit.peer-reviewe

Comparing the Clinical Effectiveness of two Cryotherapy Techniques for the Treatment of Plantar Warts

Objective. To compare two techniques of Cryotherapy for clinical effectiveness, pain, and effect on the quality of life of patients when treating plantar warts. Method. A quasi-experimental matched subject study was conducted. Twenty subjects with a newly diagnosed plantar wart were recruited. Subjects were matched for confounding variables in relation to site of lesion, gender and age, and were divided into two groups. Group A (n=10) were treated using the CO2 Gun & Probe technique whilst Group B (n=10) were treated using the Portable N2O pressurized spray technique. The plantar warts were measured at time 0 (before treatment) and Time 1(3 weeks following treatment) using a metre ruler. The Foot Function Index and the Visual Analog Scale for pain assessment during treatment were also used. Results. The study found no significant difference in the effectiveness (p= 0.387), pain caused during treatment (P=0.855) and FFI scores (p=0.172) for total change in QOL in the study group when comparing both treatments. However, comparison of the mean scores showed that the CO2 Gun & Probe method was slightly more effective in reduction of size. Pain during treatment was almost identical when using both techniques. The FFI scores on all 3 subscales (Pain, Disability and Activity Limitation) showed a larger increase in the CO2 Gun & probe method, when compared to the pressurized N2O Portable device. Conclusions. Although this study has found no significant difference between two different techniques of cryotherapy, mean differences have indicated that the CO2 Gun & Probe technique is more effective in reducing the size of the warts when compared to the N2O Pressurized Spray Technique; however the CO2 Gun & Probe technique caused a larger impact on quality of life. Recommendations from this study suggest that careful consideration is required when selecting a treatment for plantar warts and furthermore patients should be advised on the likely outcomes of each treatment before any intervention.Objective. To compare two techniques of Cryotherapy for clinical effectiveness, pain, and effect on the quality of life of patients when treating plantar warts. Method. A quasi-experimental matched subject study was conducted. Twenty subjects with a newly diagnosed plantar wart were recruited. Subjects were matched for confounding variables in relation to site of lesion, gender and age, and were divided into two groups. Group A (n=10) were treated using the CO2 Gun & Probe technique whilst Group B (n=10) were treated using the Portable N2O pressurized spray technique. The plantar warts were measured at time 0 (before treatment) and Time 1(3 weeks following treatment) using a metre ruler. The Foot Function Index and the Visual Analog Scale for pain assessment during treatment were also used. Results. The study found no significant difference in the effectiveness (p= 0.387), pain caused during treatment (P=0.855) and FFI scores (p=0.172) for total change in QOL in the study group when comparing both treatments. However, comparison of the mean scores showed that the CO2 Gun & Probe method was slightly more effective in reduction of size. Pain during treatment was almost identical when using both techniques. The FFI scores on all 3 subscales (Pain, Disability and Activity Limitation) showed a larger increase in the CO2 Gun & probe method, when compared to the pressurized N2O Portable device. Conclusions. Although this study has found no significant difference between two different techniques of cryotherapy, mean differences have indicated that the CO2 Gun & Probe technique is more effective in reducing the size of the warts when compared to the N2O Pressurized Spray Technique; however the CO2 Gun & Probe technique caused a larger impact on quality of life. Recommendations from this study suggest that careful consideration is required when selecting a treatment for plantar warts and furthermore patients should be advised on the likely outcomes of each treatment before any intervention

Rethinking diabetes education

One of the core components of diabetes care is the promotion of diabetes education to improve self-management, which would reduce the financial and personal burden that diabetes imposes. However, as education and knowledge alone do not always translate into improved metabolic outcomes, a fuller understanding of the factors that contribute to suboptimal self-management is important if improved diabetes outcomes are to be achieved. In this article the authors question the current approaches to diabetes education, and highlight how education might be broadened to produce more effective outcomes. The authors suggest a move away from traditional, didactic, diabetes-related education, which has failed in a number of settings, towards innovative approaches that are person-centred to improve metabolic outcomes and quality of life for individuals with diabetes.peer-reviewe

The diabetic foot : saving limbs, saving lives

Every 30 seconds a limb is lost somewhere in the world due to diabetes! (International Diabetes Federation and International Working Group of the Diabetic Foot, 2005) Diabetic foot ulceration and amputations are a worldwide concern, including Malta where some 500 partial or full amputations of the foot are carried out annually. In the EU, 450,000 amputations cost €2.5 billion yearly (Raghav A et al., 2018), resulting in major economic consequences both for patients and healthcare systems alike. If managed timely, ulceration may be prevented in 80% of the cases. Diabetic foot infections are potentially disastrous complications that progress rapidly following minor traumas. For a long time, scientists have been fighting against infection and it is evident that wound infection is a challenging situation for all healthcare professionals. It has been suggested that infections present in diabetic foot ulcerations are the largest cause of lower extremity amputations, impacting the patient’s quality of life significantly (Camilleri Attard F., Gatt A., Formosa C. 2021). Our research leads us to believe that an increase in pressure on the sole of the foot, followed by a rise in temperature before ulceration, can also be key indicators that could detect those areas which are about to develop a wound, known as a diabetic ulcer (Perren et al 2021). Thus identifying and correcting increased plantar pressures and altered biomechanical factors are key to prevention amongst other risk factors. Diabetic foot amputation and hospitalization are still on the increase. This may suggest that current management of the diabetic foot is not effective, clearly demonstrating the need for the implementation of new and effective strategies aimed primarily at prevention of ulceration. Where the high-risk foot is concerned, “time is tissue” (Setacci C, 2012). One cannot simply afford to wait for complications such as infection to develop as this might mean limb loss and ultimately even death. [Excerpt]peer-reviewe

La Relación entre la fascitis plantar y la presión de talón

[Abstract] Objective: The presence of increased medial heel plantar pressure in plantar fasciitis has been debated, with clinicians often utilizing pressure-relieving devices, such as heel pads and cups, as a means of management.Method: Plantar pressures in a sample of 15 adult participants with chronic plantar fasciitis were compared to plantar pressures of the 15 adult participants forming the control group, who were matched for age, gender and weight.Results: There were no significant differences in peak heel plantar pressure (p = 0.244), lateral peakplantar pressure (p = 0.876), forefoot peak plantar pressure (p = 0.576) and the Forefoot to Rearfoot peak pressure ratio (p = 0.242) between the 2 groups. However, there was a significant difference (p = 0.015) in medial heel peak plantar pressure between the 2 groups, with the plantar fasciitis group having lower medial heel pressure than the control group.Conclusion: The findings in this study suggest that there is no relationship between peak medial heel plantar pressures and chronic medio-plantar heel pain in plantar fascitis. There is also no shift in pressure from the symptomatic medio-plantar heel region to the latero-plantar heel and forefoot regions. As a result, pressure may not play a part in the pathophysiology of plantar fascitis.[Resumen] Objetivos: La presencia de incremento de presión plantar en la zona medial del talón en la fascitis plantar ha sido estudiado, y los clínicos a menudo utilizan dispositivos de alivio de la presión, como almohadillas de talón y cazoletas, como medio de manejo.Método: Las presiones plantares en una muestra de 15 participantes adultos con fascitis plantar crónica se compararon con las presiones plantares de los 15 participantes adultos que formaron el grupo control, que fueron comparados por edad, sexo y peso.Resultados: No hubo diferencias significativas en la presión plantar en el pico pico (p = 0,244), en la presión pico lateral (p = 0,876), en la presión plantar pico en el antepié (p = 0,576) Los 2 grupos. Sin embargo, hubo una diferencia significativa (p = 0,015) en la presión plantar del talón medial entre los 2 grupos, con el grupo de fascitis plantar con menor presión en el talón medial que en el grupo control.Conclusión: Los hallazgos en este estudio sugieren que no hay relación entre el pico medial del talón de las presiones plantares y crónico medio-plantar talón dolor en la fascitis plantar. Tampoco hay cambio en la presión de la región sintomática del talón medio-plantar a las regiones del talón latero-plantar y del antepié. Como resultado, la presión puede no desempeñar un papel en la fisiopatología de la fascitis planta

The application of generic CAD/CAM systems for the design and manufacture of foot orthoses

For many years, foot orthoses have been manufactured using traditional techniques over plaster of Paris casts or foam impressions. Other types of existing orthoses include pre-fabricated and heat-molded orthoses. More advanced methods of manufacturing orthoses have been developed using Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) technology. However, this type of technology is still presently expensive and thus not available to the majority of practitioners to consider as part of their routine clinical service, notwithstanding the fact that these systems offer various advantages over traditional methods. This paper provides a new methodological approach towards integrating various readily-available technologies into a foot orthoses design and manufacturing system at a cost that is attainable by the majority of practitioners. This should encourage the further utilization of this technology, from which both practitioner services and patients could possibly benefit.peer-reviewe

Shod versus barefoot walking - an ongoing debate!

Wearing shoes is second nature in modern society. However, in recent years, barefoot movement is gaining popularity among health-conscious individuals who are shunning shoes altogether. From a biomechanical point of view, the foot is one of the least understood structures of the human body. Research studies and debates on the effects of shoes on the feet are ongoing across the globe. Many researchers have concluded that people did, in fact, have feet that were in better physical condition prior to the invention of shoes. A study examined 180 modern humans from three different population groups (Sotho, Zulu, and European), comparing their feet, and to the feet of 2,000-year-old skeletons. The researchers concluded that, prior to the invention of shoes, people had healthier feet. Among the modern subjects, the Zulu population, which often goes barefoot, had the healthiest feet whilst the European, who are habitual shoe-wearers had the unhealthiest feet. However, expert opinions with regards to this subject matter are divided and depend largely on the specialized area of the expert in question. [Excerpt]peer-reviewe