Were he alive today, would Louis Pasteur still champion culture methods he pioneered over 150 years ago for identifying bacterial pathogens? Or, might he suggest that new molecular techniques may prove a better way forward for quickly detecting the true microbial diversity of wounds? As modern clinicians faced with treating complex patients with diabetic foot infections (DFI), should we still request venerated and familiar culture and sensitivity methods, or is it time to ask for newer molecular tests, such as 16S rRNA gene sequencing? Or, are molecular techniques as yet too experimental, non-specific and expensive for current clinical use? While molecular techniques help us to identify more microorganisms from a DFI, can they tell us ‘who done it?', that is, which are the causative pathogens and which are merely colonizers? Furthermore, can molecular techniques provide clinically relevant, rapid information on the virulence of wound isolates and their antibiotic sensitivities? We herein review current knowledge on the microbiology of DFI, from standard culture methods to the current era of rapid and comprehensive ‘crime scene investigation' (CSI) techniques.

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Diabetes is a growing public health problem that can lead to serious complications for the pa-tient such as foot ulcers and amputations. For affected patients the foot ulcers causes suffer-ing, pain and impaired health. The foot ulcers also contribute to major costs to the society and affects healthcare resources hard. A large part of the district nurse's work consists of wound care. Therefore it is important that the district nurse possess adequate knowledge of wound dressings to promote wound healing and thereby shorten the wound healing time. The aim of the study was to examine the wound healing time due to treatment with antiseptic or non-antiseptic dressings in elderly patients with diabetes and foot ulcers. The method used was a quantitative register study with a retrospective and descriptive design. Patients included in the study were 241 men and women aged ≥ 65 years with diabetes and healed foot ulcers. Men were represented by 68 % (n=164) and women by 32 % (n=77). The results showed no signif-icant difference in wound healing time due to treatment with antiseptic or non-antiseptic dressings. The most common non-antiseptic dressing used was polyurethane foam and the most common antiseptic dressing used was silver dressing. More research to compare wound healing time between non-antiseptic and antiseptic dressings in elderly patients with diabetes and foot ulcers are needed. District nurses need to increase their knowledge within different dressings and its positive and negative effects.

No description available.

Foot problems are not only the most common but in general also the most severe of the diabetic complications. The age group 15-50 yrs in this study was chosen because these patients were considered to be at their most active age and were felt to require optimal foot function. 380 patients (96 %) participated, 78 % with Type 1, 20 % Type 2 and 1 % with secondary diabetes mellitus (DM) and 100 healthy controls. Only six patients had signs of peripheral ischaemia but half of the patients had deformities such as fallen forefoot arches and hammer toes. With sensory thresholds and clinical signs it was demonstrated that age, duration of DM and tall stature are major risk factors for diabetic neuropathy. Gender differences depend on differences in height. Dorsiflexion of the toes against resistance was used to test the function and volume of m.extensor digitorum brevis. When compared with measurements of sensory thresholds for vibration, perception and pain, it was found to be a valuable test for screening of distal motor neuropathy. To prevent worsening of foot deformities 266 patients with Type 1 DM were followed for 3 years. Those with the most pronounced deformities were fitted with custom-made insoles and had repeated examinations. Improvement was more common in patients with insoles compared to patients without insoles. Bone mineral density (BMD) was measured in nine patients with osteopathy in their feet and 18 controls. BMD was lower in L2-L3, but not in the proximal femur, implying osteopenia being a possible risk factor for distal osteopathy. Plaster cast treatment was used in 33 diabetic patients with severe foot ulcers who were selected because previous conservative treatment had been unsuccessful and they had been judged unsuitable for vascular surgery. The lesions healed in 19 patients. In conclusion, the main findings demonstrate the need for an increased awareness of early preventive foot care in young and middle-aged diabetic patients. / <p>S. 1-46: sammanfattning, s. 47-120: 6 uppsatser</p> / digitalisering@umu

Morton’s syndrome is a foot condition where the 1st metatarsal does not protrude as far distally as the 2nd metatarsal. Clinicians believe that short 1st metatarsal protrusion affects foot mechanics and leads to painful conditions of the foot. Normal protrusion ratio of the 1st and 2nd metatarsal has not been delineated in scientific literature, and little is known about the mechanics of feet with short 1st metatarsal protrusion beyond anecdotal clinical evidence. In the first part of this two-part study, a novel tool was developed to guide metatarsal measurement and reduce measurement error so values for normal metatarsal protrusion ratios could be established. In the second part, subjects were divided into those with shorter and longer than average 1st metatarsal protrusion ratio and we measured if there were any differences in the foot-floor forces between the two groups. In Part 1, the feet of 65 healthy subjects were measured with a novel measurement tool and it was determined that the average ratio (1st metatarsal/2nd metatarsal) was 0.902, suggesting a 1st metatarsal that does not protrude as far distally as the 2nd metatarsal. For Part 2, participants were divided into two groups: the short 1st metatarsal group had a ratio of more than one standard deviation below the mean (0.866 or lower) while the control group had a metatarsal ratio of more than one standard deviation above the mean (0.938 or higher). We hypothesized that short 1st metatarsal protrusion would cause an imbalance across the forefoot because the 1st metatarsal would not be able to carry the required load on the medial side of the foot; however, the results of the gait study did not show this as only forces in the walking direction near toe-off correlated with metatarsal protrusion ratio. We can only speculate as to the relationship between the metatarsal protrusion ratio and increased shear force in the walking direction, but it is possible that to compensate for the diminished stabilizing capacity of the shorter 1st metatarsal, the foot must push off with more force to propel the body forward. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-01-14 14:38:55.255

Background. Accidental falls comprise a serious health concern in older adults. Partially accounting for the high incidence rates is postural instability. While customized foot orthotics can improve certain measures of functional stability, the purpose of this study was to explore the degree to which prefabricated orthotics benefit this population and to expand the evidence base to postural stability. Methods. Eighteen healthy older adults (72.7 ± 4.8 years) were evaluated with and without foot orthotics, and again following 2-3 weeks of use. Functional stability was evaluated via the Timed-Up-and-Go test and the Fullerton Advanced Balance scale. Computerized posturography was used to assess stability in altered sensory environments (Sensory Organization Test) and to assess overall stability limits (Limits of Stability test). A pressure analysis system assessed gait parameters and pressure distribution patterns. Results. Foot orthotics improved stability on the Timed-Up-and-Go (p=0.003) and the Fullerton Advanced Balance Scale (p<0.001) and decreased fall occurrence on the Sensory Organization Test. Times based changes of postural stability occurred for medio-lateral sway velocity and area when only the vestibular system providing accurate information (condition 5) (p=0.001, 0.05, respectively), and under sensory conflict (condition 6) for sway velocity (medio-lateral and antero-posterior), sway path length and sway area (p=0.015, 0.021, 0.015, 0.015, respectively). An interaction effect was found for maximum excursion composite score (p=0.001) on the Limits of Stability test, as well as a main effect of time for directional control in the ML direction and composite score (p=0.024.0.043). Contact area increase in the midfoot and rearfoot and peak force decreased in the rearfoot (p=0.001, 0.03, 0.027, respectively). Conclusions. Results indicate that foot orthotic use can improve functional measures of stability in older adults. It is unclear whether the time-based changes in postural stability are attributable to the orthotics or are a result of learning effects. Regardless, improvements in stability with prefabricated foot orthotics may help decrease the risk of falls in this population. / School of Physical Education, Sport, and Exercise Science

Context: Despite an association between foot structure and the incidence of lower limb injury in sport, few studies have measured the effects of neutral, pronated and supinated foot structures during dynamic activity. Furthermore, despite its widespread use as an injury prevention method, the effects of athletic taping on individuals with pronated and supinated foot structures are unclear. Objectives: To explore whether individuals with pronated and supinated foot structures have poorer lower limb neuromuscular control as measured by postural stability and muscle reaction time in comparison to those with neutral feet. Additionally, the effects of athletic taping on individuals with neutral, pronated and supinated foot structures on aspects of lower limb neuromuscular control are also examined. Subjects: All subjects used in this thesis were aged from 18 – 30 years and took part in at least two hours of exercise each week. Subjects were categorised in to groups according to navicular drop height measures; neutral 5 – 9 mm; pronated ≥ 10 mm; supinated ≤ 4 mm. Methods: Neuromuscular control was analysed in subjects with neutral, pronated and supinated feet using dynamic postural stability and muscular reaction time measures. These measures were then repeated with four athletic taping conditions (arch tape, ankle tape, proprioceptive tape and no-tape) both before and after a period of exercise. Results: Individuals with pronated and supinated foot structures were shown to have reduced postural stability in comparison to those with neutral foot structures during some dynamic tasks. Pronated and supinated foot structures also resulted in slower muscle reaction times in comparison to those with neutral feet during a tilt platform perturbation. No differences were identified between dominant and non-dominant limbs on subjects with neutral, pronated or supinated foot structures; however the high incidence of foot structure asymmetry did appear to result in differences between contralateral limbs in both postural stability and reaction time parameters. Arch and ankle taping resulted in increased neuromuscular control after application, yet these effects diminished after a period of exercise. Conclusions: The results of this thesis provide evidence to suggest that foot structure does affect lower limb neuromuscular control as measured by postural stability and muscle reaction time. In addition athletic taping has been shown to affect neuromuscular control on subjects with neutral, pronated and supinated foot structures both before and after exercise. These findings may have wide implications in sport where individuals with pronated and supinated feet may be more susceptible to injury in comparison to those with neutral feet.

Foot-and-mouth disease virus (FMDV) is one of the most contagious viruses of animals and is recognised as the most important constraint to international trade in animals and animal products. Two fundamental problems remain to be understood before more effective control measures can be put in place. These problems are the FMDV „carrier state‟ and the short duration of immunity after vaccination which contrasts with prolonged immunity after natural infection. The aim of this thesis was to study the interaction between FDMV and cells in lymphoid tissue in the natural bovine host, in order to improve our understanding of the protective immune response. Using laser capture microdissection in combination with quantitative real-time reverse transcription polymerase chain reaction, immunohistochemical analysis and corroborated by in situ hybridization, it is shown that FMDV locates rapidly to, and is maintained in, the light zone of germinal centres following primary infection of naïve cattle. Maintenance of non-replicating FMDV in these sites may represent a source of persisting infectious virus and also contribute to the generation of long-lasting antibody responses against neutralising epitopes of the virus. The role of T-lymphocyte subsets in recovery from FMDV infection in calves was investigated by administering subset-specific mouse monoclonal antibodies. Depletion of circulating CD4+ or WC1+ γδ T cells was achieved for a period extending from before challenge to after resolution of viraemia and peak clinical signs, whereas CD8+ cell depletion was only partial. Depletion of CD4+ cells was also confirmed by analysis of lymph node biopsies 5 days post-challenge. Depletion with anti-WC1 and anti-CD8 antibodies had no effect on the kinetics of infection, clinical signs and immune responses following FMDV infection. Three of the four CD4+ T-cell-depleted calves failed to generate an antibody response to the non-structural polyprotein 3ABC, but generated a neutralising antibody response similar to that in the controls, including rapid isotype switching to IgG antibody. These data suggest that antibody responses to sites on the surface of the virus capsid are T cell-independent whereas those directed against the non-structural proteins are T cell-dependent. CD4 depletion was found to substantially inhibit antibody responses to the G-H peptide loop VP1135-156 on the viral capsid, indicating that responses to this particular site, which has a more mobile structure than other neutralising sites on the virus capsid, are T cell-dependent. Depletion of CD4+ T cells had no adverse effect on the magnitude or duration of clinical signs or clearance of virus from the circulation. In conclusion, CD4+ T-cell-independent antibody responses play a major role in the resolution of primary infection with FMDV in cattle.

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2002. / Plantar fasciitis (PF) is a syndrome that causes pain at the insertion of the plantar fascia to the medial calcaneal tubercle of the calcaneaus. This syndrome has been described as an overuse injury with subsequent inflammation at the insertion of the plantar fascia to the bone. The literature describes inflammatory changes that occur within the body and attachment of the plantar fascia, together with biomechanical aberrances that may be the result of the PF. The purpose of this study was to determine the relative effectiveness of pulsed ultrasound as an adjunct to foot manipulation in the treatment of plantar fasciitis. The foot manipulations are used to correct the biomechanical abnormalities, while the pulsed ultrasound is used for its anti-inflammatory properties. The combination of pulsed ultrasound and foot manipulation was compared to foot manipulation alone to determine if this ultrasound manipulation combination had any beneficial effect over and above foot manipulation alone. Thus determining whether it is of importance to o approach and treat both aspects of the syndrome described. This was a prospective, randomised, comparative controlled trial. Forty subjects were diagnosed with plantar fasciitis and chosen to participate in the study. They were subsequently divided into two groups (Group A and Group B) of twenty. Group A was the experimental group receiving foot manipulation and ultrasound as treatment, and Group B, the control group received foot manipulation alone as treatment. Each subject received six treatments within a period of three weeks, with a seventh follow-up within one week of the sixth treatment. There was no treatment at the seventh consultation; this was used for obtaining subjective and objective readings. Subjective assessment was by means of the Foot Function Index, and objective was by means of the manual algometer. Both the subjective. and objective readings were taken prior to the first, sixth and at the seventh (final) consultations. / M