2015 CFPM WINTER GETAWAY SEMINAR. Mike Potter

Transcription

1 2015 CFPM WINTER GETAWAY SEMINAR Mike Potter A summary of The Journal of Foot and Ankle Research (JFAR) papers and implications for clinical practice

2 SEMINAR 3 Outline This presentation aims to identify a selection of the most accessed clinical publications from the Journal of Foot and Ankle Research and to highlight clinical implications. The most accessed clinical papers were selected by identifying the total number of all-time hits that the papers have received over the lifetime of their on-line publication. Some papers have been published for 5 years, others for only a few months. Papers, such as study protocols, were not considered

3 MOST ACCESSED JFAR PAPERS The top five papers (all time) of clinical significance are: Paper #1 Clinical guidelines for the recognition of melanoma of the foot and nail unit Ivan R Bristow, David AR de Berker, Katharine M Acland, Richard J Turner, Johnathan Bowling JFAR 2010, 3:25 (1 November 2010) [Number of all-time accesses 45947]*

4 TOP 5 PAPERS: #2 Acral lentiginous melanoma of the foot and ankle: A case series and review of the literature Ivan R Bristow, Katharine M Acland JFAR 2008, 1:11 (15 September 2008) [Number of all-time accesses ]*

5 TOP 5 PAPERS: #3 The reliability of toe systolic pressure and the toe brachial index in patients with diabetes Mary T Romanos, Anita Raspovic, Byron M Perrin JFAR 2010, 3:31 (22 December 2010) [Number of all-time accesses 18936]*

6 TOP 5 PAPERS: #4 The effectiveness of manual stretching in the treatment of plantar heel pain David Sweeting, Ben Parish, Lee Hooper, Rachel Chester JFAR 2011, 4:19 (25 June 2011) [Number of all-time accesses 17456]*

7 TOP 5 PAPERS: #5 The effectiveness of lasers in the treatment of onychomycosis: a systematic review Ivan R Bristow JFAR 2014, 7:34 (27 July 2014) [Number of alltime accesses 6629 ]*

8 MOST ACCESSED JFAR PAPERS An additional four papers with significant numbers accessing them in the last 12 months last 12 months #1 Contaminants in human nail dust: an occupational hazard in podiatry? Paul D Tinley, Karen Eddy, Peter Collier JFAR 2014, 7:15 (20 February 2014) [Number of accesses last 12 months 5735]**

9 LAST 12 MONTHS #2 Interventions for increasing ankle joint dorsiflexion: a systematic review and metaanalysis Rebekah Young, Sheree Nix, Aaron Wholohan, Rachel Bradhurst, Lloyd Reed JFAR 2013, 6:46 (14 November 2013) [Number of accesses last 12 months 7290]**

10 LAST 12 MONTHS #3 Unknotting night-time muscle cramp: a survey of patient experience, help seeking behaviour and perceived treatment effectiveness Fiona Blyton, Vivienne Chuter, Joshua Burns JFAR 2012, 5:17 (15 March 2012) [Number of accesses last 12 months 5622]**

11 LAST 12 MONTHS #4 A comparison of gait biomechanics of flipflops, sandals, barefoot and shoes Xiuli Zhang, Max R Paquette, Songning Zhang JFAR 2013, 6:45 (6 November 2013) [Number of accesses last 12 months 5195]**

12 MOST ACCESSED JFAR PAPERS And, one paper with significant numbers accessing in last 30 days Movement of the human foot in 100 pain free individuals aged 18-45: implications for understanding normal foot function Christopher J Nester, Hannah L Jarvis, Richard k Jones, Peter D Bowden, Anmin Liu JFAR 2014, 7:51 (28 November 2014) [Number of alltime accesses last 30days 798 ]***

13 MOST ACCESSED JFAR PAPERS As of 16 th February 2015: *Number of all-time accesses: **Number last 12 months ***Number last 30 days

14 THE CLINICAL SIGNIFICANCE OF EACH PAPER? 1. Clinical guidelines for the recognition of melanoma of the foot and nail unit Bristow et al The use of a simple acronym is a useful tool in remembering the main clinical signs of a potential melanoma.

15 BRISTOW ET AL Any mole or solitary vascular lesion whether new or pre-existing, which is growing or changing shape or colour, should be referred for a specialist opinion The ABCDE acronym is:

16 BRISTOW ET AL A - Asymmetry. One half of the lesion is not identical to the other. B Border. A lesion with an irregular, ragged or indistinct border. C Colour. Lesion has more than one colour in it. D Diameter. The lesion has a diameter of greater than 6mm. E Evolution. Any change in the lesion in terms of size, shape or colour.

17 BRISTOW ET AL C Coloured lesions where any part is not skin colour U Uncertain diagnosis. Any lesion that does not have a definite diagnosis. B - Bleeding lesions on the foot or under the nail, whether the bleeding is direct bleeding or oozing of fluid. This includes chronic granulation tissue. E Enlargement or deterioration of a lesion or ulcer despite therapy. D Delay in healing of any lesion beyond 2 months. Refer for expert opinion when any 2 features apply.

18 CLINICAL SIGNIFICANCE PAPER #2 2. The reliability of toe systolic pressure and the toe brachial index in patients with diabetes Mary T Romanos, Anita Raspovic, Byron M Perrin JFAR 2010, 3:31 (22 December 2010)

19 ROMANOS ET AL Peripheral arterial occlusive disease (PAOD) is a progressive disorder that affects approximately 25% of Australian adults over 55 years of age. The risk of PAOD is increased, occurs earlier and is often more aggressive and diffuse in patients with diabetes, particularly targeting the distal popliteal vessels.

20 ROMANOS ET AL The Australian Diabetes Society recommends that vascular screening in people with diabetes be performed annually for early diagnosis of PAOD. There is debate regarding which assessment method is most effective for diagnosis. The assessment of peripheral vascular status in a clinical setting includes questioning and clinical examination, combined with a variety of tests such as Ankle Brachial Index (ABI) and Toe Brachial Index (TBI).

21 ROMANOS ET AL Medial calcification in diabetes, known as Mönckeberg s sclerosis, causing hardening and incompressibility of arteries can affect the accuracy of ABIs. As an alternative, toe systolic pressure and TBI have been recommended as the toes have been reported to be less affected by medial calcification.

22 ROMANOS ET AL This study investigated toe systolic pressure and TBI in patients with diabetes using a manual sphygmomanometer and photoplethysmography. The findings of this study established clinically significant margins of error raising questions about the reliability of using a manual sphygmomanometer and photoplethysmograph to measure toe systolic pressure and therefore TBI.

23 CLINICAL SIGNIFICANCE PAPER #3 3. Contaminants in human nail dust: an occupational hazard in podiatry? Paul D Tinley, Karen Eddy, Peter Collier JFAR 2014, 7:15 (20 February 2014)

24 TINLEY ET AL Previous studies have shown that large amounts of nail dust become airborne during the drilling process and are present in the air for up to 10 hours after a clinical session. This increases the risk of respiratory tract infection for the practitioner.

25 TINLEY ET AL The results of this study showed podiatrists had a greater range of microbes in nasal cavities than a control group. Aspergillus fumigatus was the most commonly found fungus within the podiatrist group (44%) All podiatrists used nail drills with some form of dust extraction except one. 17% (8) of the practitioners did not use a mask whilst drilling.

26 TINLEY ET AL The high levels of Aspergillus contamination is a significant finding in the podiatry group as this fungus is small enough to enter tissue in the nasal cavity and as a small particle will stay airborne in the room for up to 16 hours. The non-use of masks and the use of inappropriate masks by podiatrists is an occupational hazard.

27 CLINICAL SIGNIFICANCE PAPER #4 4. Acral lentiginous melanoma of the foot and ankle: A case series and review of the literature Ivan R Bristow, Katharine M Acland JFAR 2008, 1:11 (15 September 2008)

28 BRISTOW & ACLAND Malignant melanoma is the commonest malignancy observed in the foot. There are 4 sub-types of melanoma Superficial spreading melanoma (SSM) Nodular melanoma (NM) Lentigo maligna melanoma and (LMM) Acral lentiginous melanoma (ALM)

29 BRISTOW & ACLAND Three of the sub-types have been reported to arise on the foot: SSM, NM and ALM LMM occurs almost exclusively on the face ALM was so named because of its predilection for acral (distal) parts of the body particularly palms, soles, sub-ungual areas and a distinct radial or lentiginous (freckled/speckled) growth phase.

30 BRISTOW & ACLAND ALM is an uncommon malignant tumour which can occur on the foot. In this case series of 27 cases, 62% occurred on the plantar aspect of the foot. A third of the cases were misdiagnosed before reaching the skin clinic.