Effect of debridement of plantar hyperkeratoses on gait in older people – An exploratory trial

Garcia, Caleb Araguas; Soler, Francisco Corbi

doi:10.1016/j.archger.2018.05.017

Cited by 10 publications

(3 citation statements)

References 70 publications

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“…Given the high prevalence of foot disease, foot disease risk factors and inappropriate footwear, as well as evidence for reduced falls [26] and foot pain [61,62] from outpatient podiatry intervention in older adults, routine podiatry assessment and intervention should be considered as part of the CGA in geriatric rehabilitation inpatients. An alternative approach to increase the rate of podiatry assessment and intervention in this population, based on this study's findings, would be to include peripheral arterial disease and risk of malnutrition as indicators for podiatry referral.…”

Section: Discussionmentioning

confidence: 99%

Incorporating foot assessment in the comprehensive geriatric assessment

et al. 2021

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Background Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults. Aims To introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks. Methods Prospective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA. Results Fifty-two patients (median age [inter-quartile range] 86.4 [79.2–90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a ‘high risk’ or ‘at risk’ foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 ‘at risk’ and 2 ‘low risk’ for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7–32.1] vs 15.2 [8–22.1] days, p = 0.01) and higher median Malnutrition Screening Test scores (2 [0–3] vs 0 [0–2], p = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist (p < 0.001). Conclusion Foot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review.

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Section: Discussionmentioning

confidence: 99%

Incorporating foot assessment in the comprehensive geriatric assessment

et al. 2021

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“…It is a frequent phenomenon, affecting 20% of the general population, it occurs more often in women and the elderly, and is becoming one of the commonest lesions seen in podiatry consultations ( 1 ). Despite being a frequent phenomenon, it is still unknown what the key pressure threshold is determining the appearance of this keratopathy ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Plantar pressures values related with appearance of mechanical hyperkeratosis before and after surgery of mild hallux valgus

et al. 2023

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BackgroundHyperkeratoses are thickenings of the stratum corneum, provoked by deviation of the ray and excessive plantar pressures. They are very common under the first metatarsal head (MTH) and on the big toe when there exists hallux valgus. The objective of this study was to assess plantar pressures pre- and post-surgery to try to define the threshold values that could determine the appearance of keratopathies.Materials and methodsSeventy-nine patients (100 feet) who had undergone percutaneous distal soft-tissue release and the Akin procedure were evaluated prospectively. The BioFoot/IBV® in-shoe system was used for objective baropodometric functional evaluations of the heel, midfoot, first through fifth MTHs, hallux, and lesser toes. The presence or absence of a hyperkeratosis (HK) or plantar callus under the first MTH or hallux was recorded. The average follow-up time at which the measurements were repeated was 28.1 months.ResultsPre-surgery, 62 feet presented a painful HK on the big toe, while post-surgery, only 9 of the feet presented the same lesion. Patients who presented a prior HK at the first metatarsophalangeal (MTP) joint had a mean pressure of 417.2 ± 254.5 kPa as against a value of 359.6 ± 185.1 kPa for the rest. Post-surgery, these values dropped to 409.8 and 346.3 kPa, respectively.ConclusionPatients with HK presented an 11% greater mean pressure than those without. The values obtained with the BioFoot/IBV® system in the present study can therefore be considered predictive of the appearance of HK under the first MTH and on the side of the big toe.

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“…IPKs are mostly found in women, in people who spend long hours standing and in people having foot deformities that modify pressure points like bunions and hammer toes [3]. Despite the different types of treatment currently available for IPKs (keratolytic ointments, partial offloading with orthotic devices, insoles, paddings and therapeutic shoes, moisturizers and emollients, bleomycin sulfate or hyaluronic acid or silicone injections), the treatment of choice is scalpel debridement alone [4,[15][16][17][18][19][20][21][22][23][24][25]. Conservative treatment are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms [26,27].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of saline water and lidocaine injection treatment of intractable plantar keratoma: a randomised feasibility study

Mercier

Blanchette

Cantin

et al. 2021

Journal of Foot and Ankle Research

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Background An intractable plantar keratoma (IPK) is a conical thickening of the epidermis’ stratum corneum and a common cause of foot pain which can have a significant, detrimental impact on the mobility, quality of life and independence of individuals. Conservative treatments are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms. The purpose of this study was the evaluation of the feasibility, safety and effectiveness of innovative treatments for intractable plantar keratoma (IPK). Methods A randomized single blind trial with 40 patients divided with block randomization in four parallel groups was conducted to compare treatment combinations: conservative sharp debridement only or sharp debridement with needle insertion, physiological water injection or lidocaine injection. All patients obtained the same treatment four times at a four-week interval. At each visit, visual analog scale (VAS), Foot Function Index (FFI) and IPK size were evaluated. VAS and FFI were also completed at a six and twelve-month follow-up. Results Our findings in regards to feasibility demonstrated recruitment challenges because of the anticipated pain that would be provoked by needle insertion may not be worth the potential pain relief compared to debridement alone from the patient’s perspective. This was also the principal cause of drop out. Our preliminary results show no main effect of group for any of the clinical outcomes: pain felt on VAS, FFI score, IPK’s size (p > 0.05). However, the analysis revealed a statistically significant effect of time on VAS (p < 0.001), FFI score (p < 0.001) and IPK’s size (width and depth (p < 0.001); length (p = 0.001)), but no group x time interaction was found (p > 0.05). Conclusions This study demonstrates that IPK treatment consisting of sharp debridement with needle insertion, physiological saline water injection or lidocaine injection is feasible and safe. There was a non-statistically significant trend toward diminishing pain intensity compared to scalpel debridement alone. The pain provoked by needle insertion and injection treatments must be addressed with a scientifically proven protocol to make it more comfortable for patients before these treatments could be considered in further studies. Trial registration ClinicalTrials.gov, NCT04777227. 2 March, 2021 - Retrospectively registered (All participants were recruited prior to registration).

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Effect of debridement of plantar hyperkeratoses on gait in older people – An exploratory trial

Cited by 10 publications

References 70 publications

Incorporating foot assessment in the comprehensive geriatric assessment

Incorporating foot assessment in the comprehensive geriatric assessment

Plantar pressures values related with appearance of mechanical hyperkeratosis before and after surgery of mild hallux valgus

Effectiveness of saline water and lidocaine injection treatment of intractable plantar keratoma: a randomised feasibility study

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