Podiatry
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Item Development of a prognostic model for stump healing in major lower limb amputation among the diabetic population(MDPI, 2021-07-12) Ashraff, Suhel; Siddiqui, Muhammad; Carline, Tom; Rush, Robert; Santos, Derek; Raza, ZahidBackground: This study aimed to explore the effect of haematological markers as well as patient characteristics on stump healing in patients who underwent a lower limb amputation procedure. In addition, a practical model regarding factors that affected stump healing was developed. Methods: Patients who underwent a major lower limb amputation (above knee and below knee) at the Royal Infirmary of Edinburgh from the period of 2007 to 2010 were included in this study. A prognostic model utilizing backward stepwise logistical regression was developed to measure the probability of lower limb stump healing. The relationship between the dependent and independent variables was identified using univariate and multivariate logistic regression. Results: Three variables, namely serum sodium, serum creatinine and serum high density lipid cholesterol were identified which influenced stump healing. Patients with normal serum sodium were 75% more likely to have lower limb stump healing compared to that of patients with abnormal serum sodium (odds ratio [OR] 1.756; 95% confidence interval [CI] 1.048–2.942). Patients with normal serum creatinine were 66% more likely to have their stump healed (OR 1.664; 95% CI 0.94 to 2.946). The healing rate of patients with a normal level of serum high density lipid cholesterol was 75%, in contrast to patients with an aberrant level of serum high density lipids cholesterol (OR 1.753; 95% CI 1.061 to 2.895). The effectiveness of the retrospective stump-healing model was demonstrated by the area under the ROC curve (0.612), which was supported by the Hosmer and Lemeshow goodness-of-fit test (p = 0.879). Conclusions: Serum sodium, serum high density lipid cholesterol and serum creatinine have a strong correlation with lower limb stump healing. However, serum sodium and serum high density lipid cholesterol secondary to multiple co-morbidities in this cohort group could be altered secondary to disease pathology itself.Item Prediction of stump healing in lower limb amputation: A narrative review(Mark Allen Group, 2019-12-11) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, TomBoth types of diabetes, as well as different forms of acquired diabetes, are associated with diabetic peripheral neuropathy. Diabetic foot ulcers (DFU) is the condition most commonly related to somatic peripheral neuropathy, often leading to gangrene and limb amputation. Independent from large-vessel disease, sensory loss may result in DFU development and even amputation. The crucial part of any lower limb amputation is the stump healing process, which represents the central goal of postoperative management. Despite the importance attributed to this process, a standard set of guidelines regarding efficient healing methods is yet to be formulated. Health professionals are faced with the challenge of assessing the different risk factors and deciding which has a greater influence on the stump healing rate. There is currently an insufficient number of studies regarding factors effecting lower limb amputation. The main purpose of this review is to discuss the markers that can be helpful in the prediction of stump healing in patients who have undergone lower limb amputation.Item Predictive parameters of arteriovenous fistula maturation in patients with end-stage renal disease(Korean Society of Nephrology, 2018-09-30) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Rush, Robert; Carline, Tom; Raza, ZahidBackground:The objevctive of the present study was to explore the potential influence of blood markers and patient factors such as risk factors, kidney function profile, coagulation profile, lipid profile, body mass index, blood pressure, and vein diameter on the maturation of arteriovenous fistula (AVF) in patients with end-stage renal disease. Methods:Retrospective data from 300 patients who had undergone AVF creation at the Royal Infirmary of Edinburgh were examined. A predictive logistic regression model was developed using a backward stepwise procedure. Model performance, discrimination, and calibration were assessed using the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test. The final model was externally validated by 100 prospective patients who received a new fistula at the Royal Infirmary of Edinburgh. Results:A total of 400 (300 retrospective and 100 prospective) patients were recruited for this study, with a mean age of 60.14 ± 15.9 years (development set) and 58 ± 15 years (validation set), respectively (P = 0.208). Study results showed that males were twice as likely to undergo fistula maturation as females, while patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula and a preoperative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation as compared with a vein size of less than 2.5 mm. The model for fistula maturation had fair discrimination, as indicated by the area under the ROC curve (0.68), but good calibration as indicated by the Hosmer-Lemeshow test (P = 0.79). The area under the receiver operating curve for the validation model in the validation set was 0.59. Similarly, in the validation set, the Hosmer-Lemeshow statistic indicated an agreement between the observed and predicted probabilities of maturation (P > 0.05). Conclusion:Gender, PVD, and vein size are independent predictors of AVF maturation. The clinical utility of these risk categories in the maturation of AVF requires further evaluation in longer follow-up.Item Complications of Stump Healing Among Diabetic Population(Society of Endocrinology and Metabolism of Turkey, 2018-06-19) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, TomLower limb amputation is a major procedure performed in diabetic patients with multiple comorbidities. Almost 10% of the National Health Service budget is taken up by diabetes, with diabetes-related complications accounting for 80% of the costs. The process of wound healing is complex and involves regenerating the cellular organization and the tissue layers. Diabetics are five times more predisposed to wound infection than patients without diabetes mellitus. The amputated stump frequently becomes infected due to inadequate blood circulation, a weak immune system, and poorly controlled diabetes mellitus. Pain, stump edema, and osteomyelitis are significant complications associated with lower limb amputation wounds. A number of factors may substantiate the need for re-amputation, such as stump pain and/or phantom limb pain, delayed stump infection, the formation of symptomatic bone spurs, assessment of the skin flap designed to preserve stump length, and preparation of the stump for the prosthetic device. There are currently no reliable standards that can be referred to prior to leg amputation. The clinicians, therefore, have to rely on their judgment and investigatory parameters. The main purpose of this review is to discuss the difficulties of stump healing in the diabetic population.Item A survey of babywalkers in GP's, health visitors and orthopaedic surgeons(The Society of Chiropodists and Podiatrists, 1999) Cashley, D.; Carline, TomItem Accidental intra-arterial injection -a cause of lower limb ischaemia in intravenous drug users(The Society of Chiropodists and Podiatrists, 1998) Weir, Evelyn C.; Carline, TomItem A modular device to measure the effects of plantar foot pressure on the microcirculation of the heel(Elsevier Science Ltd, 2003-03) Santos, Derek; Carline, Tom; Richmond, R.; Abboud, R.Background: Past research has concentrated on foot function and plantar foot pressure, with many devices developed for this purpose. However, little is known of how cutaneous blood flow compensates for ambulatory repetitive circulatory insults and how ulceration occurs. Objectives: To develop a system to measure the effects of plantar foot pressure on cutaneous blood flow in the supine and semi-weight bearing positions. Method: A system was developed that integrated a laser Doppler fluxmeter with a pressure probe, allowing plantar foot pressure and skin blood flow to be recorded simultaneously. The system was tested using four volunteers (288.6 years). Results: A significant difference existed between baseline laser Doppler flowmetry (LDF) in the supine and semi-weight bearing positions (P=0.023). Differences between both positions also existed in the reduction in LDF levels following application of pressure (P=0.015), the maximum hyperaemic response (P=0.034) and time taken to reach maximum hyperaemic response (P=0.019). Conclusion: The device has shown that with current technology it is now possible not only to investigate plantar foot pressure but also how it affects skin blood flow, which in some cases can lead to ulceration. The effect of plantar foot pressure on cutaneous blood flow differs depending on whether the subject is supine or semi-weight bearing. Thus, to understand the effects of plantar foot pressure on skin blood flow future researchers must ensure that subjects are in an upright position when recording.Item A study to ascertain the potential inhalation hazard of toenail dust(The Society of Chiropodists and Podiatrists, 2003-02) Donaldson, C. L.; Carline, Tom; Brown, D. M.; Gilmour, P. S.; ELEGI Colt Laboratories; Donaldson, K.The use of the podiatric nail drill has become an acceptable way of reducing onychogryphotic nails in the clinical setting. The present study has demonstrated the presence of particles that are potentially dangerous to the human lung when they are contaminated with bacterial endotoxin (bacterial cell wall components that may cause an inflammatory response). Toenail dust collected from podiatric nail drills was examined for size, endotoxin content and the ability to stimulate release of IL-8 (IL- interleukins stimulate the release of other mediators in septic shock and inflammation) from macrophages and lung epithelial cells in vitro. The size distribution revealed a large number of particles that would deposit in the nose, airways and lung alveoli. Endotoxin was detected in extracts of nail particles and, interestingly, a component of these particles was able to stimulate substantial release of IL-8 from lung epithelial cells. Suspensions of toenail particles stimulated IL-8 release from monocyte-derived macrophages. Destruction of the endotoxin with the antibiotic polymyxin B still resulted in IL-8 release, suggesting that the particles themselves initiated the response and not necessarily the endotoxin. The authors conclude that podiatrists who routinely carry out nail reduction could be inhaling particles that could deposit throughout the respiratory tract, where they could contribute to inflammation by stimulating release of IL-8 from cells via the particles themselves and via endotoxin.Item Pre-formed orthoses in Juvenile Idiopathic Arthritis [JIA]: preliminary results from an RCT(2011-09) Coda, Andrea; Carline, Tom; Santos, DerekBackground: Currently there is limited evidence supporting podiatric treatment of children with JIA. This trial aimed to determine whether pre-formed cost-effective orthoses impacted on pain, quality of life (primary outcomes) and/or gait-parameters (secondary outcomes) in children affected by JIA. The RCT aims to strengthen and add new knowledge to the podiatric management of children affected by this paediatric condition. Methods: The study took place at the Gait Analysis laboratory at Queen Margaret University – Edinburgh and at the TORT Centre, Ninewells Hospital-Dundee. Children with JIA, as diagnosed by a consultant paediatric rheumatologist, were block randomised by a computer generator. Intervention was blinded to the patients. The trial group received Slimflex Plus insoles, with the addition of chair side corrections and the control insole supplied was made with leather board (1mm thick) without corrections. Both insoles had the same black EVA top cover. Primary outcome measures were recorded at each of the 3 data recording appointments over the 6 months period, using validated questionnaires such as VAS, CHAQ and PedsQL. Tekscan™ equipment (F-Scan™ and HR Walkway®) measured in-shoe pressure and force data with and without orthotic intervention, using same type of sensors of equal resolution. Multiple foot strikes and repetitive gait patterns were compared pre and post-treatment. In addition, the HR Walkway® captures multiple sequential footsteps during barefoot walking; allowing barefoot and in-shoe measurements to be compared. Results: Sixty children were recruited; 48.3% (n=29) control and 51.7% (n=31) active treatment group. Within the control group 20.7% (n=6) of patients were male. Within the active treatment group, 29% (n=9) subjects were male. Age ranged between 5 to 18 years, mean age for the control group was 11.17(SD3.51) and for the trial group were 10.64 (SD3.84). In order to attribute any effect solely on the FOs intervention, details of changes of medication and/or new joint injections were recorded during the trial. 65.5% (n=19) of the control group were on stable medications. 74.2% (n=23) of the children receiving active treatment were on stable medication. Overall, 99.4% (n=179/180) appointments were completed and contributed to this preliminary data analysis. Significant improvement was identified in the primary outcomes favouring active treatment with regards to pain and quality of life measures: VAS (p<0.05); PedsQL paediatric-generic (p<0.05) Peds paediatric rheumatology (p<0.05); PedsQL parent generic (p<0.05); PedsQL parent rheumatology (p<0.05). In all these quality of life tools, clinical significance was also obtained. Significant differences were also identified between the groups for gait time, stance time, total plantar surface, heel contact, midfoot, 5th metatarsal head and distal phalanx. Conclusion: The results show that pre-formed orthoses are effective in improving pain, quality of life and most gait parameters in JIA children. This research also provides new evidence to the role of podiatrists within the multidisciplinary team in paediatric rheumatology and hopes to raise the profile of podiatrists working within the paediatric hospitals and private practices.Item Obesity and insulin resistance: Management in diabetes(2013-09) Ashraff, Suhel; Siddiqui, Muhammad A.; Carline, TomObesity today, is a major public health problem across the world. The rapid increase in the incidence of obesity and associated co-morbidities presents a major challenge to health care globally. Insulin resistance is commonly associated with obesity and other life style diseases. However, much uncertainty remains about the mechanism regarding the association between insulin resistance and human disease mainly because of the difficulties of defining insulin resistance in clinical terms and of quantifying insulin action in humans. This review looks at the available literature concerning the link between obesity and insulin resistance and discusses the various approaches of their management.