Im Zuge systematisch durchgeführter thermografischer Untersuchungen an 95 Asiatischen Elefanten in europäischen Zoos konnten physiologische Wärmeprofile aller nicht von Fußkrankheiten betroffener Elefanten erstellt werden. Um eine objektivere Befundung zu ermöglichen, wurden dafür definierte Messbereiche an den Füßen festgelegt und deren Temperaturdaten als Wärmekurven für jeden Zeh dargestellt. Es zeigte sich, dass die Bandbreite von Temperaturen gleicher Messbereiche starken individuellen Schwankungen unterliegt, weshalb eine Befundung nicht anhand absoluter Temperaturwerte erfolgen sollte. So wurden über gleichen Messbereichen unterschiedlicher Elefanten Temperaturunterschiede von bis zu 8 °C festgestellt. Auch die Umgebungsfaktoren während der Untersuchung tragen zu dieser Varianz bei. Bei Umgebungstemperaturen zwischen 17,5 °C und 23 °C stellt sich durch Erhöhung der Außentemperatur um 1 °C eine um 0,5 °C erhöhte Wärmeabstrahlung über der Haut dar. Eine Erhöhung der Luftfeuchte um 1 % verursacht eine um 0,03 °C vermehrte Wärmeabstrahlung. Die Wärmeprofile stellten sich für die Kronsaum- und Hufwandbereiche der Zehen eines Fußes von medial nach lateral in einem parabelförmigen Verlauf dar, wobei die höchsten Temperaturen an den kranialen Zehen gemessen wurden. Die Differenz zwischen Kronsaum- und Hufwandbereichen blieb dabei konstant. Die Temperaturen der Zehenregion oberhalb des Kronsaums folgten nicht dieser Parabelform, lagen aber, außer an der jeweils medialen Seite, konstant unterhalb der Kronsaumtemperaturen. Bei Vergleich mit thermografischen Befunden erkrankter Zehen zeigte sich meist ein starker Anstieg der Zehenregiontemperatur weit über die Kronsaumtemperaturen hinaus, weshalb sich dieses Verhältnis als Indiz für ein akutes Enzündungsgeschehen nutzen lässt. Ein gleichmäßiges Wärmeprofil, welches möglichst dicht dem in dieser Arbeit entwickelten Profil gleicht und konstante Temperaturdifferenzen zwischen den einzelnen Messbereichen aufweist, ist ein gutes Indiz für einen gesunden Fuß. Thermografische Befundungen sollten immer mit Hilfe herkömmlicher visueller Auswertung und zusätzlich der Erstellung eines Wärmeprofils vorgenommen werden, um die Subjektivität zu minimieren. Erstmalig wurden in dieser Arbeit drei Elefanten mittels Pedografie untersucht, um Aufschlüsse über die Druckverteilung unter dem Elefantenfuß zu erhalten. Wie bei Menschen und pedografisch vermessenen Rindern fanden sich auch beim Elefanten charakteristische Druckprofile. Druckspitzenwerte tauchten hierbei vor allem im kranialen Bereich der Füße als Druckleiste, aber auch im kaudalen Bereich in Form zweier Druckpfeiler auf. Experimente mit einer Methode zur Simulierung weicheren Untergrundes schienen die Druckspitzenwerte etwas abzuschwächen und das allgemeine Druckprofil einzuebnen, waren aber nur schwer auszuwerten. Die Methode eignet sich ebenso zur Erfassung der tatsächlich belasteten Fläche der Füße, welche sich bei stärkerer Belastung, beispielsweise dreibeinigem Stehen, vergrößerte. Trotz noch einiger methodischer und technischer Probleme, eröffnet sich mit der Pedografie ein sicherlich lohnenswertes Forschungsfeld für weitere Studien, die einen besseren Einblick in die Druckphysiologie des Elefantenfußes gewähren könnten. Weiterhin wurden in dieser Arbeit Daten der Elefantenhaltungssysteme von 17 besuchten europäischen Zoos, sowie Daten über Häufigkeit und Art der Gliedmaßenkrankheiten und anderer gesundheitlicher Parameter aller 95 untersuchter Elefanten ausgewertet. Hierbei zeigte sich immer noch starker Verbesserungsbedarf im Hinblick auf Innengehegegrößen und die verwendeten Bodenmaterialien. Auch Bewegungsprogramme für den Aufenthalt im Außengehege wurden nur in weniger als der Hälfte der Zoos eingesetzt. Positiv fiel auf, dass die Elefanten in den besuchten Zoos kaum noch angekettet werden und falls doch, nur kurzzeitig zu Untersuchungszwecken. Den Daten der Haltungsanalysen entsprechend, fielen die Auswertungen zur Fußgesundheit aus: Nur 36 % der untersuchten Elefanten litten bisher noch niemals unter Fußerkrankungen. Allein zum Zeitpunkt der Untersuchung wurden bei 27 % der Tiere akute Erkrankungen festgestellt, die unter Behandlung standen. Hierbei handelte es sich hauptsächlich um Abszesse oder andere entzündliche Veränderungen im Bereich des Nagelbetts. Weiterhin wurden 30 % der Elefanten als übergewichtig eingeschätzt und 36 % der Tiere zeigten stereotype Bewegungsmuster. / A total of 95 Asiatic Elephants in 17 European zoos were systematically examined using a high resolution thermographic camera and physiologic heat profiles of elephant’s feet without known foot diseases were established. To allow a more objective evaluation of thermographic findings, the feet and toes were divided schematically into defined areas for measurement purposes, based on anatomical features for which the temperature data was then plotted to produce heat curves for each area. Measurements of temperatures pertaining to similar areas of different elephants showed strong individual fluctuation. Temperature variation was as high as 8 °C in similar areas between elephants. Thus, evaluation of thermographic findings should never be based on absolute temperature readings alone. This strong variation is partly caused by environmental factors during the examination. With environmental temperatures between 17,5 °C and 23 °C, a one degree increase of this temperature will cause a 0,5 °C increase of the heat radiation of the feet. An increase of air humidity by 1 % will cause an increase of 0,03 °C of the measured thermographical heat radiation. The physiological heat profiles for coronary and hoof wall areas of the toes showed an arched, parable-like shape when plotted from the medial over the cranial to the lateral toes. The highest temperature readings were found on the cranial toes. The difference between coronary and hoof wall temperatures of similar toes were constant all over the foot. The physiological heat profiles of the toe areas above the coronary region did not show this arched shape but stayed below the coronary temperature readings except on the medial toe. On comparison with thermographic findings of inflammated toes, a strong increase of this area above the coronary band was found which exceeded the temperature of the coronary region. This characteristic can be used as an indicator for acute inflammations. A regular heat profile, which resembles closely the physiological heat profile created in this study and which shows constant temperature differences between the defined areas of the single toes, is a good indicator of healthy foot. It is recommended that thermographic examinations always are evaluated using conventional observation of the heat patterns in conjunction with the additional creation of a heat profile to minimize subjectivity by the clinician. For the first time three elephants were examined in this study using a new pedographic method to gain information on the pressure distribution below the elephant’s foot. As found in humans as well as in pedographically examined cows, the pressure distribution in elephant’s feet showed a characteristic profile. Pressure peaks showed up especially in the cranial area of the foot, possibly the border between sole and pad, as well as in the caudal region in the shape of two pressure pillars. Experiments with a method to simulate softer ground seemed to lower the pressure peaks slightly in favor of a broader distribution, but were very difficult to evaluate, especially considering the small sample size. This method is also suited to register the actual area size put under pressure by the elephant, which was shown to rise under increased pressure, e. g. three legged standing. Despite some encountered methodical and technical problems, pedography of elephants is going to be a very promising field for further scientific studies in order to acquire more information on the physiology of pressure distribution. Data on husbandry conditions of the 17 visited zoos and as well as data on frequency and type of foot diseases and other health parameters of all 95 examined elephants were also collected and evaluated. A strong need for improvement was observed in terms of enclosure sizes and the surface materials used in indoor enclosures. Also, daily routines to increase activity of the elephants in the outdoor enclosures were found to be carried out only in half of the visited zoos. On a positive note, elephants in the evaluated zoos were hardly ever chained and if so, only for examination purposes. According to the data of the husbandry evaluation the information on the current status of foot health showed the need for improvement: Only in 36 % of the examined elephants foot problems were so far not encountered. On the time of examination 27 % of the animals were found to be under ongoing treatment for foot diseases. Mostly these were abscesses or other inflammation processes in the area of the nail’s laminar tissue. Out of the study sample, 30 % of the elephants were estimated to be overweight and 36 % showed stereotypic movement patterns.

Made available in DSpace on 2016-06-02T20:19:17Z (GMT). No. of bitstreams: 1 4154.pdf: 1491739 bytes, checksum: e7a8dd2211d1d67bedf80ba53cf53305 (MD5) Previous issue date: 2012-03-02 / Universidade Federal de Sao Carlos / The foot and ankle joint complex comprising an adaptable to external and internal influences, being able to tolerate and compensate for deformities or misalignment of the lower limb. Shoes are an important addition to the human foot. However, if used improperly interfere in gait, cause pain and foot deformities. The objective of this study was to investigate the influence of aging on the anthropometric and postural foot of the elderly, through Manuscript I. As well as pointing out the consequences and the factors associated with the use of inappropriate shoes for a period of four years, through the Manuscript II. For this purpose, 164 elderly patients with mean age of 73.7 (± 5.86) years were evaluated in 2006 and 2010, as the anthropometric and postural foot (Manuscript I), and asked about falls, shoe model used, pain during the use of footwear and options to buy it (Manuscript II). The paired t-test was used in the first study to point out possible differences in anthropometric variables over time. In the second study, subjects were classified among those who remained inadequate lengths of wearing shoes and those who remained using appropriate footwear, excluding the subjects who changed their behavior in the period in question. A multiple logistic regression model and the observations of the odds ratio evaluated the impact of independent variables in the classifications of this behavior. In all statistical tests, was considered a significance level of 5%. The results of study I showed a decrease of the angles of the first metatarsophalangeal joint and increase the values of arch index during the study period. The perimeters, heights and widths, and the postures of the feet showed no changes during the study period. The results of study II show that the foot length and males are the main factors associated with persistence of misuse of shoes over the years, and the shoes too long in relation to the feet of individuals. Other variables, such as falls, shoes models, pain, width, perimeter and height of the feet, or even the posture of the feet showed no association with this behavior. The study period may not have been enough to point out significant changes in other variables, and longer studies are needed to state the possible occurrence of these changes. Still, it is possible to ensure the importance of these findings for better understanding of the complex biomechanics of the feet of the elderly, planning strategies and guidelines for the elderly to help prevent the installation of deformities and limitations. / O pé e o tornozelo compõem um complexo articular adaptável a influências externas e internas, sendo capaz de tolerar e compensar deformidades ou má postura do membro inferior. Os calçados são um complemento importante ao pé humano. Entretanto, se usados inadequadamente interferem na marcha, causam dor e deformidades nos pés. O objetivo deste estudo foi verificar a influência do envelhecimento sobre as variáveis antropométricas e posturais dos pés de idosos, por meio do Manuscrito I. Bem como apontar as conseqüências e os fatores associados ao uso de calçados inadequados num período de quatro anos, por meio do Manuscrito II. Para tanto, 164 idosos com média de idade de 73,7(±5,86) anos foram avaliados em 2006 e em 2010, quanto a variáveis antropométricas e posturais dos pés (Manuscrito I), além de questionados sobre quedas, modelo de calçado utilizado, dor durante o uso de calçados e opções ao comprá-lo (Manuscrito II). O teste-T pareado foi utilizado, no primeiro estudo, para apontar as possíveis diferenças nas variáveis antropométricas ao longo do tempo. No segundo estudo os indivíduos foram classificados entre aqueles que permaneceram utilizando calçados de comprimentos inadequados e aqueles que permaneceram utilizando calçados adequados, sendo excluídos os sujeitos que mudaram de comportamento no período em questão. Um modelo de Regressão Logística Múltipla e a observação da Odds Ratio (razão de chances) avaliaram o impacto das variáveis independentes na classificação deste comportamento. Em todos os testes estatísticos, foi considerado um nível de significância de 5%. Os resultados do estudo I apontaram uma diminuição dos ângulos da primeira articulação metatarsofalangeana e aumento dos valores de índice do arco durante o período estudado. Os perímetros, alturas e larguras, bem como as posturas dos pés não apresentaram modificações no período do estudo. Os resultados do estudo II revelam que o comprimento do pé e o gênero masculino são os principais fatores associados à permanência de uso incorreto de calçados no decorrer dos anos, sendo os calçados excessivamente compridos em relação aos pés dos indivíduos. Outras variáveis, como quedas, modelos de calçados, dor, larguras, perímetros e alturas dos pés, ou mesmo a postura dos pés não apresentaram associações com este comportamento. O período estudado pode não ter sido suficiente para apontar alterações significativas nas demais variáveis estudadas, e estudos mais longos são necessários para afirmar a possível ocorrência destas alterações. Ainda assim, é possível assegurar a importância desses achados para melhor compreensão acerca da complexa biomecânica dos pés de idosos, planejando estratégias e orientações aos idosos que visem prevenir a instalação de deformidades e limitações.

Die Einrichtungen der Verkehrsunfallforschung Hannover und (ab 1999) Dresden registrierten 736 Beinverletzungen eines Schweregrades AIS ≥ 2 im Zeitraum von 1983 bis März 2007. 174 dieser Verletzungen (23,6 %) waren Frakturen und Luxationen des Fußes und des oberen Sprunggelenkes. Es waren 149 Füße von 141 Frontinsassen (140 PKW) betroffen. Die Insassen untergliederten sich in 117 Fahrer und 24 Beifahrer. Das durchschnittliche Alter der Insassen betrug 38.5 ± 16.8 Jahre. Die häufigste Verletzung war die Fraktur des oberen Sprunggelenkes (n=82; 80 Malleolarfrakturen, 2 Pilonfrakturen). 34 Frakturen und Luxationen betrafen den Rückfuß (5 Talus- und 26 Calcaneusfrakturen, 2 subtalare Luxationen, 1 subtotale Amputation), 16 den Mittfuß (4 Navicularefrakturen, 5 Cuboidfrakturen, 3 Cuneiformefrakturen, 2 Chopart-Gelenksluxationen, 1 subtotale Amputation, 1 schweres Decollement) und 39 den Vorfuß (Metatarsalefrakturen). Offene Frakturen wurden nur in 3 Fällen registriert (2 Malleolarfrakturen, 1 Metatarsalefraktur). In 10 Fällen wurden beide Füße verletzt. 33 Insassen (23,4 %) waren polytraumatisiert, davon starben 17. 81 % der Insassen waren angeschnallt. Die verunfallten PKW wurden in prä- (Baujahr 1997 und älter) und post-EuroNCAP- (Baujahr 1998 und jünger) Fahrzeuge unterteilt. Die meisten Fußverletzungen fanden sich in prä-EuroNCAP-Autos. Die meisten Insassen befanden sich in Fahrzeugen der unteren Mittelklasse (40 Fahrer und 9 Beifahrer) und der Mittelklasse (27 Fahrer und 7 Beifahrer). 49 der 140 Unfälle ereigneten sich auf Landes- bzw. Kreisstraßen, 26 auf Bundesstraßen und 13 auf Autobahnen. Es wurden überwiegend Frontalzusammenstöße beobachtet. Zwischen den verletzten Fußregionen fanden sich keine signifikanten Unterschiede hinsichtlich der Delta v- und EES-Werte, es ergab sich aber ein Trend zu höheren Delta v- und EES-Werten bei neueren PKW (post-EuroNCAP). Die Häufigkeit von Fußverletzungen stieg linear mit steigendem Delta v-Wert, oberhalb eines Delta v-Wertes von 55 km/h kam es nur noch in prä-EuroNCAP-Autos zu einem weiteren linearen Anstieg, während post-EuroNCAP-Fahrzeuge keinen weiteren Anstieg der Verletzungshäufigkeit zeigten. Die Fußraumintrusion zeigte keine signifikanten Unterschiede zwischen den einzelnen Fußregionen, jedoch zeigte sich in post-EuroNCAP-Fahrzeugen ein Trend zu höheren Intrusionswerten. Zwischen den einzelnen Fahrzeugklassen zeigten sich keine Unterschiede in der Fußraumintrusion. Nur 29 der 174 Frakturen und Luxationen des Fußes und des oberen Sprunggelenkes wurden in post-EuroNCAP-Fahrzeugen registiert, die überwiegende Zahl dieser Verletzungen (n=145) ereignete sich in prä-EuroNCAP-Fahrzeugen. Bei Betrachtung des AIS2008-assoziierten FCI (functional capacity index) für die Fußregion zeigte sich eine geringere Wahrscheinlichkeit einer dauerhaften Behinderung in post-EuroNCAP-Fahrzeugen bei gleichem Delta v-Wert.:1. Einleitung zur Unfallforschung in Deutschland 6 2. Fragestellung 10 3. Patientengut und Methodik 13 4. Charakteristische Frakturen und zu Grunde liegende Unfälle 23 5. Auswertung 28 5.1 Erfasste Verletzungen 28 5.2 Charakterisierung der Fahrzeuge 32 5.2.1 Fahrzeugsegment 32 5.2.2 Unfallort 33 5.2.3 Aufprallrichtung 35 5.2.4 Verletzungsverursachendes Fahrzeugteil 36 5.3 Geschwindigkeitsparameter bei den beobachteten Verletzungen 37 5.4 Fußraumintrusion bei den beobachteten Verletzungen 41 5.5 Häufigkeit von Fußverletzungen 53 6. Diskussion 54 7. Zusammenfassung 67 8. Literaturverzeichnis 69 Danksagung 95 Thesen zur Dissertation 96 / The accident research of Hanover and (from 1999 on) Dresden registered 736 leg injuries (AIS ≥ 2) from 1983 to March 2007. 174 of these injuries (23.6 %) were fractures or dislocations of foot and ankle. 149 feet of 141 front seat car occupants in 140 cars were affected. Of these 117 were drivers, 24 were front seat passengers. The mean age of occupants was 38.5 ± 16.8 years. Ankle fractures were the most frequent injury (n = 82; 80 malleolar fractures, 2 pilon fractures). 34 fractures and dislocations affected the hindfoot (5 talus and 26 calcaneal fractures, 2 subtalar dislocations and 1 subtotal amputation) , 16 to midfoot (4 navicular fractures, 5 cuboid fractures, 3 fractures of cuneiformia, 2 dislocations of chopart joint, 1 subtotal amputation, and one severe decollement) and 39 the forefoot (metatarsal fractures). Open fractures were seldom seen (2 malleolar fractures, 1 metatarsal fracture). Both feet were injured in 10 cases. 33 occupants (23.4 %) were polytaumatic had a polytrauma, 17 of them died. 81 percent of the occupants were belted. The cars were divided in pre EuroNCAP (year of manufacture 1997 and older) and post EuroNCAP cars (year of manufacture 1998 and newer). Most of the foot injuries were seen in pre EuroNCAP cars. Most of the occupants sat in compact cars (40 drivers and 9 front seat passengers) and large family cars (27 drivers and 7 co-drivers). 49 of 140 accidents occurred on country roads, 26 on main roads and 13 on motorways. The crash direction was mostly frontal. Generally were found no differences of delta v- and EES-level between the injured foot regions, but divided into pre- and post-EuroNCAP cars there was a tendency to higher delta v- and EES-levels in newer cars. The frequency of foot injuries increased linearly with increasing delta v-level; but above delta v-level of 55 km/h the linear increase only was seen in pre-EuroNCAP cars, post-EuroNCAP cars showed no further increase of injuries. The footwell intrusion showed no difference between the injured foot regions but post-EuroNCAP cars had a tendency to higher footwell intrusion. There were no differences in footwell intrusion between the car types. Only 29 of 174 fractures or dislocations of foot and ankle were seen in post-EuroNCAP cars, the predominate number of these injuries (n = 145) were noticed in pre-EuroNCAP cars. A lower probability of long-term impairment was found in post-EuroNCAP cars for equal delta v levels, using the AIS2008 associated Functional Capacity Index (FCI) for the foot region.:1. Einleitung zur Unfallforschung in Deutschland 6 2. Fragestellung 10 3. Patientengut und Methodik 13 4. Charakteristische Frakturen und zu Grunde liegende Unfälle 23 5. Auswertung 28 5.1 Erfasste Verletzungen 28 5.2 Charakterisierung der Fahrzeuge 32 5.2.1 Fahrzeugsegment 32 5.2.2 Unfallort 33 5.2.3 Aufprallrichtung 35 5.2.4 Verletzungsverursachendes Fahrzeugteil 36 5.3 Geschwindigkeitsparameter bei den beobachteten Verletzungen 37 5.4 Fußraumintrusion bei den beobachteten Verletzungen 41 5.5 Häufigkeit von Fußverletzungen 53 6. Diskussion 54 7. Zusammenfassung 67 8. Literaturverzeichnis 69 Danksagung 95 Thesen zur Dissertation 96

Bakgrund: Diabetes mellitus är en kronisk sjukdom som ökar över hela världen. De drabbade individerna får diabetesrelaterade komplikationer som uppkommer vid sjukdomen, bland annat fotkomplikationer såsom fotsår som är vanligt förekommande. Komplikationerna leder till stort lidande för personen. Förutom att det leder till lidande för personen så medför det stora kostnader för hälso- och sjukvården. Uppkomst av fotsår kan motverkas och förhindras genom kunskap och utbildning. Syfte: Författarna vill i denna litteraturstudie belysa diabetespatienters behov av kunskap och undervisning gällande primär prevention av fotsår. Metod: Studien har utförts som en kvalitativ litteraturstudie där tio vetenskapliga artiklar har inkluderats. Artiklarna söktes via de två databaserna PubMed och CINAHL. De inkluderande artiklarna var med kvalitativ ansats. Resultatet av artiklarna bearbetades, analyserades, kvalitetsgranskades och sammanställdes. Resultat: Resultatet framfördes genom två huvudkategorier som är egenvårdsåtgärder och patientutbildning. Genom egenvård är patienterna delaktiga i sin vårdplan. Informationen av egenvårdsåtgärder ska inkluderas i första informationsmötet med patienten. I patientutbildning ges den information och rådgivningen som behövs för att patienten ska kunna hantera sin sjukdom. Dessutom leder patientutbildning till motivation och bättre hälsofrämjande vanor. Konklusion: För att fotsår ska undvikas bör patienten ha kunskaper om vilka komplikationer diabetes kan orsaka. Genom att ha en tydlig bild om hur komplikationerna förhindras leder det till förbättrad omhändertagandet av fötterna. Kommunikationen mellan patienten och vårdpersonalen är en avgörande faktor för hur väl informationen nås fram. / Background: Diabetes mellitus is a chronic disease that is on the rise worldwide. The affected individuals get diabetes-related complications that arise from the disease, including foot complications that are common. The complications lead to great suffering for the person. In addition to suffering for people, it also entails huge costs for health care. The onset of foot ulcers can be counteracted and prevented through knowledge and education. Purpose: In this literature study, the authors want to shed light on diabetic patients' need for knowledge and education regarding the primary prevention of foot ulcers. Method: The study was conducted as a qualitative literature study where ten scientific articles have been included. The articles were searched through the two databases PubMed and CINAHL. The included articles were with a qualitative approach. In the background, both qualitative and quantitative articles were included. Only qualitative articles were included in the results. The results of the articles were processed, reviewed and compiled. Results: The results were presented through two main categories, which are self-care measures and patient education. Through self-care, patients are involved in their care plan. The information of self-care measures must be included in the first information meeting with the patient. In patient education, the information and advice need to enable the patient to manage that their illness is provided. In addition, patient education leads to motivation and better health-promoting habits. Conclusion: To avoid foot ulcers, the patient should have knowledge of what complications diabetes can cause. By having a clear picture of how the complications are prevented, it leads to improved care of the feet. The communication between the patient and the care staff is a decisive factor in how well the information is obtained.

Bakgrund: Diabetes drabbar allt fler människor och utgör ett hot mot folkhälsan. Följdsjukdomar som fotkomplikationer är vanliga. Fotsår resulterar i sänkt livskvalitet för personen som drabbas och ger ökade samhällskostnader. Regelbunden fotundersökning förebygger fotsår och utgör en rekommenderad intervention. Trots existerande riktlinjer är det skillnader i genomförandet av fotundersökningen vilket skapar ojämlik vård. I ett projekt har ett formulär baserat på riktlinjerna för fotundersökning utarbetats med syfte att underlätta och säkerställa en årlig fotundersökning med grund i evidens. Syfte: Att utvärdera vårdpersonals erfarenheter av att arbeta enligt ett formulär för strukturerad fotundersökning hos patienter med diabetes. Metod: Kvalitativ innehållsanalys utifrån Graneheim och Lundman. Studien är en del av ett projekt ” Optimerat omhändertagande av personer med diabetes och fotkomplikation” med Västra Götalandsregionen som forskningshuvudman. Semistrukturerade intervjuer genomför dessom fokusgruppintervjuer samt som enskilda intervjuer. Totalt inkluderades åtta informanter av olika yrkestillhörighet vilka intervjuades angående sina erfarenheter av formuläret i kliniskpraxis. Resultat: Formuläret underlättade arbetet vid fotundersökningen genom ökad tydlighet, struktur och överblick. Formuläret kunde bidra till att likrikta fotundersökningen eftersom skillnader i arbetssätt synliggjordes. Vid fotsår upplevdes riskkategorierna som motsägelsefulla. Osäkerhet framkom angående definitioner av exempelvis förhårdnader och svårläkta sår. Förhoppningarna var att ett införande i digitalt journalsystem skulle underlätta dokumentationen och synliggöra fotundersökningen, med ökad tillgänglighet för alla berörda. Slutsats: Formuläret fungerar väl som stöd och beslutsunderlag i det preventiva arbetet med fotundersökningen och kan komma att bidra till likriktning av fotundersökningen enligt gällanderiktlinjer och därmed bidra till en säkrare och mer jämlik vård. / Background: Diabetes is a growing threat to public health. Secondary diseases like footcomplications are common. Foot ulcers affect individual’s quality of life and are a great cost to society. Regular foot examination prevents foot ulcers and is a recommended intervention. Despite existing guidelines there are differences in the execution of the foot exam which causes care inequality. A structured foot exam form based on the guidelines was developed in a project. The aim was to facilitate the foot exam and contribute to a uniform execution. Aim: To assess health care workers experiences of working with a structured foot exam form for patients with diabetes Method: Qualitative content analysis based on Graneheim and Lundman. The study is part of a larger project entitled “Optimized care of persons with diabetes and foot complications” with Västra Götalands region as responsible authority. Semi structured interviews were held in a focus group and individually with eight informants of different professions who were interviewed regarding their experiences of working with the form in clinical practice. Results: Experiences of working with the form were that it simplified the foot exam by giving itan overview and clear structure. Using the form made apparent differences in work routines between individuals. It was believed that by implementing the form routinely that it would contribute to a more uniform execution. When the patient had foot ulcers the risk categories were perceived as contradictory. There was an uncertainty about the definition of for example chronic ulcers and callosities. The hope was that the future digital format would simplify documentation and elucidate the foot exam as well as contribute to accessibility for all concerned. Conclusion: The foot exam form works well as a support during the preventative foot exam, gives a basis for decision making and could contribute to a uniform, safer foot exam with more care equality that is consistent with the current guidelines.

No description available.

Children with cerebral palsy (CP) have a higher than normal O2 uptake (VO2) during walking. While various interventions are used to improve locomotion, little is known about their effect on the metabolic and cardiopulmonary cost of walking. We therefore assessed the effects of one popular intervention, hinged ankle foot orthoses (AFO), on cardiopulmonary and metabolic variables during 2 min of steady state treadmill walking at three speeds: 3 kph, comfortable walking speed (CWS) and fast walking speed (FWS). We also assessed the effect of these braces on comfortable and maximum ground walking speed and on gross motor abilities using the Gross Motor Function Measure. Ten children with spastic diplegic CP (9.01 years ± 2.10) who habitually used hinged AFO participated. Not all children could walk at all speeds on the treadmill however, and some cardiopulmonary and metabolic data on three children were missing due to equipment failure. We performed an ANOVA on data for children who walked at 3 kph and CWS (n=8 for heart rate (HR); n=9 for pulmonary ventilation and metabolic variables) and a t-test on data at FWS (n=9 for HR, n=8 for pulmonary ventilation and metabolic variables). When children wore AFO, absolute VO2 was reduced by 4.6% at 3 kph and by 4.1% at FWS, and absolute VO2 per metre walked by 4.6% and 4.4% at the same speeds, respectively. Adjusting VO2 for body mass, or for resting VO2 or calculating energy expenditure in kJ, revealed the same pattern. Pulmonary ventilation was lower with AFO on by 7.17%, but only at 3 kph. AFO did not affect gross motor abilities. Nor did it affect HR, or the respiratory exchange ratio at any speed, nor any physiologic variable at CWS. We suggest the lower O2 cost may reflect an increase in stability and a corresponding decrease in coactivation of lower limb antagonistic muscles. / Thesis / Master of Science (MSc)

Thesis (M.Tech.: Homoeopathy)-Dept. of Homoeopathy, Durban Institute of Technology, 2006 xx, 108 leaves / Tinea pedis, more commonly known as “Athlete’s foot”, is a common acute infection that occurs in warm, humid climates (Fitzpatrick, et al. 1992:98). Warmth, humidity, trauma and occlusion such as non-breathable footwear increase the susceptibility to infection (Prescott, et al. 1999:814). The infection can become chronic in people who are more susceptible such as patients who are immuno-suppressed or those who have Diabetes mellitus (al Hassan, et al. 2004: 1). The aim of this placebo-controlled double-blind study was to evaluate the effectiveness of a topical naturopathic complex comprising of Allium sativum mother tincture (Ø), Hydrastis canadensis (Ø), Apis mellifica (D3) and Urtica urens (D3) (in an aqueous cream base) in the treatment of Tinea pedis. The complex utilized in this study is regarded as naturopathic because the remedies comprising the complex were selected for the following reasons: •Allium sativum and Hydrastis canadensis, each utilized in mother tincture, were selected for their antifungal properties. •Apis mellifica and Urtica urens, each utilized in D3 potency were selected because their skin symptomotology most accurately matched the symptoms associated with “Athlete’s foot”.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa. 2015. / Background: Plantar fasciitis (PF) is inflammation of the plantar surface of the foot, usually at the calcaneal attachment and is most commonly due to overuse. It is the most common foot condition treated by healthcare providers. Conservative treatment using taping is one of the first lines of treatment for PF. Low-Dye taping and Kinesio taping are two types of taping techniques commonly used to treat PF. Low-Dye taping and Kinesio taping have different intrinsic tape properties as well as different mechanisms of action in the treatment of PF. Low-Dye taping involves the use of a non-stretch, rigid tape. Rigid tape is commonly used by therapists primarily for the mechanical properties the tape provides to support the injured structure as well as to protect against re-injury. Low-Dye taping shortens the distance between origin and insertion of the plantar musculature and fascia, decreasing stress and tensile forces along the plantar plate to protect the plantar fascia and allow healing to occur. Kinesio tape is an elastic tape that allows a one-way longitudinal stretch; it is applied in a specific manner to achieve its therapeutic effects and forms convolutions on the skin. The proposed mechanism of action of Kinesio tape involves improving circulation of blood and lymphatics to resolve oedema caused by the inflammatory component of PF; suppressing pain, and; relieving muscle tension to return fascia and muscle functioning to normal. Both forms of tape have shown effectiveness in the treatment of PF; however the effectiveness of one taping technique versus the other has not yet been explored. Objectives: The purpose of this study was to determine the effectiveness of Kinesio tape alone versus Low-Dye tape alone in the treatment of PF in terms of both objective and subjective measures. Methods: Thirty participants with a diagnosis of PF, between the ages of 20 and 45, were randomly allocated into two treatment groups. Both groups received treatment in the form of a taping technique, either Kinesio tape or Low-Dye tape. Assessments were made pre-treatment at each visit and at a follow up visit, with seven visits in total. Assessments included objective data measures (ultrasonography, algometer readings, weight-bearing ankle dorsiflexion measurements) and subjective measures (the visual analogue scale and the foot function index questionnaire). Data was recorded in a data collection sheet and Statistical Package for the Social Sciences version 21 was used to analyze the data with a p value of < 0.05 considered as being statistically significant. Results: Most outcomes showed a significant improvement over time regardless of which form of treatment they received. For the VAS and pain walking outside, in the disability section of the FFI, there was statistical evidence of the Kinesio tape group improving more than the Low-Dye tape group. For morning pain, in the pain section of the FFI, and pain climbing curbs, in the disability section of the FFI, there was statistical evidence of the Low-Dye tape group improving more than the Kinesio tape group. For all the other outcomes there was a non-significant trend towards the Low-Dye tape group showing a greater improvement than the Kinesio tape group. Conclusion: Kinesio taping and Low-Dye taping were both found to be effective in the treatment of PF with neither form of tape showing superiority to the other in the treatment of PF.

Aims: The intravenous application of the chlorite-based drug solution WF10 is known to improve wound healing in patients with diabetic foot syndrome. In this retrospective study, we addressed the question, which effects are caused by this drug in patients with diabetic foot ulcers on the hemoglobin A1c value. Methods: Patients received five consecutive daily infusions of WF10. Three patients received a second cycle of WF10, and one patient a third cycle. Results: On a group of twelve patients with diabetic foot syndrome, WF10 gradually reduced the HbA1c values from a high-risk range (9.1 ± 1.6% (76 ± 13 mmol/mol)) into a low-risk range in all patients but one. These values remain low over at least 8 to 12 weeks after the administration of WF10. This drug improved also considerably wound healing processes in eleven patients. Conclusions: The chlorite component of WF10 is known to inactivate efficiently free cytotoxic hemoglobin forms that might accumulate in peripheral blood after hemolysis and induces the removal of predamaged red blood cells from circulation. By these mechanisms WF10 diminished toxic effects of hemolysis, improved microcirculation and glucose consumption in affected tissues, and prevented, thus, below knee amputation.