Foot and Nail Care
F1. Diagnosis and Treatment of Hand Dermatitis
Alavi A, Skotnicki S, Sussman G, Sibbald RG. Advances in Skin and Wound Care. 2012;25(8):371-380.
Article Type: Integrative review
Description/Results:
* Reviews prevalence of hand dermatitis among nurses (33% in the United States) and differential discussion of the pathology, presentation, and management of the following types of dermatitis: irritant contact dermatitis; allergic contact dermatitis; atopic dermatitis; dyshidrotic dermatitis; hyperkeratotic dermatitis.
* Emphasizes principles of skin health: routine use of moisturizers to maintain at least 10% water content of skin; humectants for hyperkeratotic dermatitis only; avoidance of common allergens (eg, neomycin); use of vinyl gloves with/without cotton liners; etc.
What does this mean for me and my practice?
Helpful to clinicians dealing personally or professionally with hand dermatitis.
F2. Shear-Reducing Insoles to Prevent Foot Ulceration in High-Risk Diabetic Patients
Lavery L, LaFontaine J, Higgins K, Lanctot D, Constantinides G. Advances in Skin and Wound Care. 2012;25(11):519-524.
Article Type: Research study
Description/Results:
* Randomized controlled trial involving 299 patients with diabetic neuropathy and loss of protective sensation, foot deformity, or history of foot ulcer; 150 patients received standard insole and 149 received shear-reducing insole. Patients also received therapeutic footwear, diabetic foot education, and regular evaluation by a podiatrist. Insoles were replaced every 4 months and patients were followed for 18 months to determine incidence of foot ulceration.
* 3 ulcers developed in the group with shear reducing insoles, as compared to 10 in the standard insole group; however, the difference did not reach statistical significance.
What does this mean for me and my practice?
Provides preliminary evidence that insoles designed to reduce both shear and pressure may be more effective in preventing diabetic foot ulcers than insoles designed to address pressure alone.
F3. Screening for the High Risk Diabetic Foot: A 60-Second Tool (2012)
Sibbald RG, Ayello E, Alavi A, Ostrow B, Lowe J, et al. Advances in Skin and Wound Care. 2012;25(10):465-476.
Article Type: Research study
Description/Results:
* Provides an overview of rationale underlying development of a simple tool to identify patients at high risk for diabetic foot ulcers, a description of the tool, and initial validation results.
* Risk factors assessed by the tool include history of ulcer or amputation; presence of foot deformity or ingrown nail; absence of both pedal pulses; presence of foot lesions (blisters, ulcers, fissures, or calluses); and loss of protective sensation (failure to detect 5.07 monofilament at > 4/10 sites).
What does this mean for me and my practice?
Provides data supporting the use of simple screening tool for identification of patients at high risk for diabetic foot ulcers; important for any wound clinician caring for diabetic patients.
F4. Reliability and Predictive Validity of Inlow's 60-Second Diabetic Foot Screen Tool
Murphy C, Laforet K, Da Rosa P, Tabamo F, Woodbury MG. Advances in Skin and Wound Care. 2012:25(6):261-266.
Article Type: Research study
Description/Results:
* Authors report on the use of a screening tool designed to quickly determine an individual's risk for development of neuropathic ulcers and related complications.
* Tool was used to assess 69 subjects and demonstrated strong intrarater and interrater reliability. Assessment of predictive validity was limited by the short study period (5 months).
What does this mean for me and my practice?
Provides initial review of an assessment tool that can be used at the bedside to rapidly screen a diabetic patient for evidence of neuropathic or ischemic changes. While further study is needed, initial findings are very promising.
F5. Elective Diabetic Foot and Ankle Surgery
Sroa N, Karlock L. Podiatry Management. November/December 2012:113-116.
Article Type: Integrative review
Description/Results:
* Authors review indications for surgical intervention in management of foot ulcers (ulcers associated with high risk of further breakdown; ulcers that fail to heal with conservative treatment), and describe specific procedures that may be of benefit (Achilles tendon lengthening, Panmetatarsal head resection, digital surgery).
* Authors point out that in select patients surgical intervention may be the only intervention that promotes healing and/or prevents an amputation.
What does this mean to me and my practice?
Would be of benefit to any wound clinician who manages patients with diabetic foot ulcers; provides very helpful insight into the potential positive role of surgical intervention for these patients.
F6. A Retrospective Analysis of Amputation Rates in Diabetic Patients: Can Lower Extremity Amputations Be Further Prevented?
Alvarsson A, Sandgren B, Wendel C, et al. Cardiovascular Diabetology. 2012;11(18):1-11.
Article Type: Research study
Description/Results:
* Authors conducted retrospective review of records for patients undergoing amputations between 2000 and 2006 to determine whether or not the Consensus Guidelines for Foot Care had made an impact on the numbers of patients with diabetes undergoing amputation.
* Data revealed that the rate of major amputations for persons with diabetes (PWD) decreased by 60%. In addition, data analysis revealed that common comorbidities for these patients were foot infections and kidney disease, that males undergoing amputations were younger than females and underwent more repeat amputations, and that only 30% of PWD undergoing amputation had been referred to a multidisciplinary team.
What does this mean to me and my practice?
Provides objective data supporting the profound impact of evidence-based consensus guidelines on patient outcomes.
F7. Exploring the Impact of Structured Foot Health Education on the Rate of Lower Extremity Amputation in Adults With Type 2 Diabetes
Amaeshi IJ. Diabetic Foot Journal. 2012;(Clinical Supplement):1-8.
Article Type: Systematic review
Description/Results:
* Authors evaluated foot health education studies using the RCT Critical Appraisal Skills Program; only 8 of 59 studies met the inclusion criteria (1 each from the United Kingdom, Australia, Taiwan, and global representation, and 4 from the United States).
* Study outcomes indicated that persons with newly diagnosed diabetes should be offered foot-care education as recommended by the National Institute for Clinical Excellence guidelines, and that foot health education is effective in reducing/delaying the onset of diabetes mellitus-related complication, but should be used as 1 component of a comprehensive management program.
* Authors note that health care practitioners should be appropriately trained to provide opportunistic diabetic education (teaching moments), and point out that educational approaches should incorporate motivational strategies such as a behavioral change contract.
What does this mean to me and my practice?
Provides objective data regarding benefits of foot care education, and specific guidelines for using education effectively to improve outcomes. Critical information for any clinician providing diabetic foot care.
F8. The Effects of a Foot and Toenail Care Protocol for Older Adults
Chan H, Lee D, Leung E, et al. Geriatric Nursing. 2012;33(6):446-453.
Article Type: Research study
Description/Results:
* Authors compared outcomes for older adults receiving either structured foot and nail care (78) or routine foot and nail care (72); structured protocol included comprehensive assessment, specific interventions, and client education.
* Most common foot and nail problems identified among study participants were hallux valgus, calluses, tinea pedis, and onychomycosis. 89.3% of participants had some type of foot or nail problem (52% nail problems, dermatologic conditions 47.3%, bone deformity 38%, and circulatory problems 16%).
* Outcomes suggested better outcomes among intervention group and failure to address foot and nail problems among the control group; however, the study was limited by short length of stay, quasi-experimental design with convenience sampling, and weak cause-and-effect relationship.
What does this mean to me and my practice?
Supports the fact that a systematic routine basic foot care protocol is essential for management of common foot, skin, and nail conditions of the older population in an acute care setting.
F9. Plantar Fasciitis
American College of Physicians. Annals of Internal Medicine. January 3, 2012:ITC 1-2-14.
Article Type: Integrative review (CME)
Description/Results:
* Authors review prevalence and annual cost of plantar fasciitis, and usual trajectory (most cases resolve spontaneously within 2 years).
* Authors review simple measures that should be used as initial interventions: rotating shoes, stretching, taping, icing, weight loss, off-loading inserts, activity modification, and nonsteroidal anti-inflammatory drugs.
What does this mean to me and my practice?
Provides comprehensive information and guidelines for management of plantar fasciitis; important for any clinician who manages foot issues.
F10. The Biomechanics of Aging
Eckles R. Podiatry Management. February 2012:147-157.
Article Type: Integrative review (CME)
Description/Results:
* Authors review impact of walking on overall health, point out that falls are the leading cause of death among individuals 65 years and older, and address aspects of gait that impact on safety, as well as comorbidities that increase the risk of falls (eg, pulmonary issues and complications of diabetes).
* Authors also address measures that improve walking safety: therapeutic shoes, stretching, strengthening, flexibility exercises, weight loss, arch supports, timely interventions for dizziness, therapy to include range-of-motion exercises, and appropriate referrals to orthotist/pedorthist, physical therapist, or occupational therapist.
What does this mean to me and my practice?
Provides valuable information related to fall prevention; relevant to any clinician providing routine foot care.
F11. The Certified Foot Care Nurse and Importance of Comprehensive Foot Assessments
Gallagher D. Journal of Wound, Ostomy and Continence Nursing. 2012;39(2):194-196.
Article Type: Integrative review
Description/Results:
* Author reviews importance of foot assessment, and critical parameters to be included in foot and nail assessment: gait, range of motion, hygiene, vascular status, sensorimotor status, skin integrity, nail status, footwear, foot pain, and presence or absence of common foot and nail pathologies.
* Author reviews major goals of WOCNCB Foot and Nail Care Nurses: assessment; preventive foot and nail care; management of common problems; and appropriate education and referrals, all of which result in limb salvage, fall prevention, pain reduction, and improved quality of life.
What does this mean to me and my practice?
Provides a summary of the WOCNCB Board Certified Foot and Nail Care Nurse's role in providing quality care especially for the neglected older population.
F12. The Diagnosis and Treatment of Diabetic Neuropathy for the Nonneurologist
Hovaguimian A. Practical Diabetology. May/June 2012:8-12.
Article Type: Integrative review
Description/Results:
* Provides a structured approach to the diagnosis and management of common diabetic neuropathies for the nonneurologist, and emphasizes importance of prompt management of weakness, pain, atrophy, loss of sensation, and dry skin in order to prevent falls, wounds, and amputations. Specific strategies include tight glucose control; appropriate use of medications, compression, and therapeutic footwear; and foot and nail care.
* Author emphasizes importance of referral to a neurologist for patients with atypical presentations, mononeuropathies, or complex pain syndromes.
What does this mean to me and my practice?
Provides a comprehensive review of diabetic neuropathy important for any clinician focusing on the lower extremity.
F13. Preventing Falls in the Elderly
Richie DH. Podiatry Today. September 2012:38-51.
Article Type: Integrative review
Description/Results:
* Author reviews impact of falls in the elderly population (to include injury-related deaths) and notes that fall prevention requires an intricate system of neuromuscular control.
* Author identifies risk factors for falls: lack of foot and nail care, toe/foot anomalies, inappropriate footwear, walking barefoot or with socks only, gait impairment, foot pain, limited range of motion, polypharmacy (4 or more medications), and recent discharge from hospital (2 weeks).
* Author also describes critical "fall prevention" interventions: exercise and balance training, properly fitted footwear, home safety surveillance, medication modification, off-loading, measures to improve visual acuity, and appropriate referrals.
What does this mean to me and my practice?
Provides a comprehensive review of risk, causes, and outcomes of falls in the older population; extremely relevant to any clinician providing routine foot and nail care for the elderly.
F14. Nail Disorders as Signs of Pediatric Systemic Disease
Shah KN, Rubin AI. Current Problems in Pediatric and Adolescent Health Care. 2012;42:204-211.
Article Type: Integrative review
Description/Results:
* Provides review of changes in the nail unit that can be caused by systemic diseases in children and adults and that typically require further investigation: onychomadesis; Beau's, Terry's, Lindsay's, Mee's, or Muehrchke's lines; splinter hemorrhages; onycholysis; koilonychia, leukonychia, and clubbing.
What does this mean to me and my practice?
Provides a comprehensive review with photos of nail conditions that may be indicative of systemic disease; very helpful reference and "alerts" for any clinician providing routine foot and nail care.