Healthy Feet & Lower Legs R. Gary Sibbald, MD, M.Ed, D.Sc (Hons), FRCPC (Med, Derm), FAAD, JM Professor of Public Health & Medicine University of Toronto Director of International Interprofessional Wound Care Course & Masters of Science - Public Health (Prevention & Wound Care) Clinical editor Advances in Skin & Wound Care 1
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Healthy
Feet & Lower Legs
R. Gary Sibbald, MD, M.Ed, D.Sc (Hons), FRCPC (Med, Derm), FAAD, JM
Professor of Public Health & Medicine
University of Toronto
Director of International Interprofessional Wound Care Course & Masters of Science - Public Health (Prevention & Wound Care)
Clinical editor Advances in Skin & Wound Care
1
Dr. Sibbald’s Potential Conflicts of Interest:Unrestricted educational grant from Valeant Pharmaceuticals
to develop the Healthy foot ScreenClinical Editor- Advances in Skin & Wound Care
Company/ Agency Paid Lecturers
Advisory Board Members
ResearchParticipants
Systagenix/ Acelity √ √ √
Mölnlycke √ √ √
RNAO- Registered Nurses Association of Ontario
√ √
Galderma √
Leo √
Hollister √ √ √
Health Point/ Smith & Nephew √ √
Valeant √ √ √
Abbott/ Abbvie √ √ √
MH-LHIN, MHLTC, HQO = Province of Ontario Government
√ √
Eli Lilly Canada Inc. √
Ferris Manufacturing Comp √
Objectives
Participants will:
Discuss the
Simplified 60 sec. screen for high risk diabetic foot
Promote foot health
Review the development and
validation of a quick efficient
foot screen for all patients
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4
Focus on Prevention:
60 Second Screening
•History
•Inspection - abnormalities
•Palpate pulse
•Deformity
•Monofilament testing
(4 out 10 negative)
After Inlow 60 sec exam
Available at www.diabeticfootscreen.com
www.WoundPedia.com
• Any 1 positive result indicates high risk status
Tool for High Risk Diabetic Foot: Validation & Clinical Pilot: Simplified 60 Second Diabetic Foot Screening ToolM. Gail Woodbury, R. Gary Sibbald , Brian Ostrow, Reneeka Persaud, Julia M. Lowe
Published: June 29, 2015-Open Access- Impact Factor 10.14
Major Amputations at Main Referral Hospital, Guyana
Risk Months Mean
St.
dev
95%
CI T test
Before
DFC 42 7.95 3.99 1.24 P <
0.0001After
DFC 42 4.14 2.36 0.73
48% reduction from pre-project levels
48 limbs saved each year =
192 limbs to July 2012
68% reduction in monthly proportion of DFU
despite 75% increase in DFU admissions
Lowe, Sibbald. Ostrow et al. PLOS Med April 2015Open Access IF= 10.14
PLoS Med. 2015 Apr; 12(4):
The Guyana Diabetes and Foot Care Project
Why is Foot Health Important?
75% of populations will experience foot pain
The foot contains 26 bones, 133 joints, 107 ligaments, and 19 muscles
The average wear and tear on a foot is equivalent to the distance a person covers in a lifetime, which is about 115,000 miles.
Physical ailments can first manifest in the foot:
diabetes
arthritis
peripheral vascular disease
cardiac disease
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http:// www.wellnessmag.com/
article/feet-how-important-are-they
A foot out of alignment cam result in discomfort
and pain to the foot, ankle, knee, hip, and back (e.g. Reflexology)
• Preliminary draft of healthy foot screen developed
• Planning committee meeting with interdisciplinary wound care experts & sponsor
• Working draft of healthy foot screen developed
Validation day – 18 patients screened by 11 assessors
Fungal scrapings & bacterial swabs
Feedback from assessors & round table discussion – revised version of screen
• Statistical analysis - reliability scores
• Items with < 0.6 reliability score removed from screen
• Final draft of healthy foot screen produced for piloting
• Piloting of healthy foot screen on 120 patients over 2 months
• Final working version of the healthy foot screen will be produced
Development and validation of a healthy foot screening tool
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Data analysis
28Data entered in SPSS Cronbach’s alpha calculated
Elements with < 0.6 reliability score were removed from screen (highlighted)
Healthy foot screening tool
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Conclusion
A healthy foot screening tool will enable clinicians, especially primary care providers, to identify common foot problems (onychomycosis, infection/ inflammatory lesions, bony abnormalities, vascular insufficiency, etc.)
Early diagnosis and treatment can prevent amputations & result in improved patient quality of life & optimize resource allocation
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My grandchildren
Sophie Grace’s first dress-
6 weeks old
A good big brother
Sophie Grace and Luke Gary
Parking lot 32
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Onychomycosis Is a Common Nail Disease
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12
6.5
0
10
20
30
40
EstimatedOnychomycosis
Population
Office Visits Diagnosed Patients
Millio
ns
Source: Scott-Levin PDDA. MAT October 2002.
Photograph: collection of A Gupta
Differential Diagnosis of Onychomycosis
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• Disease at other sites
• Nail ridging
• Splitting or thinning
• Loss of nails• Proximal pterygium
Lichen Planus
Eisman et al. BMJ. 2014;348:g1800.
Trauma Image: Alex Lozupone
Afifi et al. Can Fam Physician. 2005 Apr;51:519-25.
American Academy of Dermatology National Library of Dermatologic Teaching Slides.