Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Title: Use of orthopaedic insoles in childhood Supervisor: PhDr. Tereza Nováková, PhD. Problem definition: The importance of the longitudinal arch is one of the most discussed topics in orthopaedics. Similarly important is the indication of orthopaedic insoles for flat feet especially in children. Experts have different opinions about what age insoles should be prescribed, and if their use is beneficial. So far, a clearly defined boundary has not been established between real pathology and a flexible flat foot formed on the basis of hypermobility which is to some extent physiological in childhood. Aim: To compare the plantograms of groups of six-year-old children with diagnosed pes planus/planovalgus before and after six month (or more) use of, individually prepared, insoles. To compare the results with a group of children that did not have insoles prescribed and on this basis to judge whether there was change (improvement) that can be proven with the use of a plantogram. Method: Two groups of six-year-old subjects were formed. The experimental group: subjects with prescribed orthopaedic insoles, and the control group: subjects that were not prescribed orthopaedic insoles. Plantograms were evaluated with the help of the Chippaux-Šmiřák index method. Conclusion: The results indicate a partial...

Introduction: Lower limbs are ones of the most strained body parts to which people do not pay much attention. Conscientious care is absolutely vital for their right functioning. Main aims of the thesis: This thesis is focused on gathering the knowledge and skills in care of lower limbs with people at their adult and old age; and on describing how the care is being performed with the target group of people. The next aim is to describe the health care from the podiatry nurse´s point of view. Methodology: A qualitative research by means of half-structured interviews was chosen as the main method of the survey. People at their adult and old age from České Budějovice were interviewed, as well as a nurse working in the centre of podiatry. Results of the thesis: The research proves some level of knowledge in the field of care of lower limbs both with the adult and elderly citizens. Both these groups of people take care of their lower limbs. The results show conscientiousness with washing their feet and drying them especially in the spaces between their toes. On the one hand, the interviewed people take care of their feet by means of using lotions and by means of pedicure. However, they do not go to see specialists in pedicure. On the other hand, the results show that this kind of skin care is not very regular. The care devoted to nails seems to be problematic, it is necessary to add some information about a more appropriate way of cutting them. The results of choosing shoes; when the choice is based mainly on a fashionable look of shoes; show a bigger need of repeated and more accurate education in this field. The impacts of improperly chosen shoes, irregular care of the lower limbs and also underestimating of prophylactic medical checks were all evident on our informants´ feet. The outputs gained in practice: The intermediate results of this thesis were presented at the Students Scientific Conference. The results of the research were used as the basis for a workshop intended for people at the adult and old age. A suggested educational mental map can be used as a practical tool.

Dans le contexte de l’augmentation de l’espérance de vie et de l’obésité ainsi qu’avec les changements environnementaux et culturels, la prévalence du diabète est à la hausse ainsi que ses complications inhérentes tels l’ulcération plantaire diabétique (UPD), l’amputation au membre inférieur (AMI) et les risques d’infection associés. Une façon efficiente de gérer ces complications est la prise en charge en équipe multidisciplinaire (ÉMD) et les soins de pieds intégrés en incluant plusieurs professionnels, dont le podiatre. Dans l’optique d’améliorer les résultats pour la santé de cette population, cette thèse a pour objectifs de développer de nouvelles connaissances pour la compréhension du rôle du podiatre et de ses interventions, réalisées en contexte seul ou en ÉMD, dans la prise en charge de l’UPD et de l’AMI ainsi que d’explorer spécifiquement une nouvelle possibilité de matériel pour la prévention de la colonisation bactérienne des UPDs principalement associée à Staphylococcus aureus. Les travaux de recherche s’insèrent dans une approche intégrative faisant appel aux domaines théorique, pratique et expérimental utilisant différentes approches méthodologiques telles la revue systématique avec méta-analyse, l’étude cohorte comparative et l’étude expérimentale in vitro. Cela a conduit à trois articles scientifiques; les deux premiers traitent spécifiquement des effets des interventions du podiatre en approche d’ÉMD sur les résultats pour la santé (données sur l’UPD, l’AMI et l’utilisation des ressources dans le système de la santé) et le dernier concerne l’effet antibactérien d’un produit potentiel pour la gestion locale des infections des UPDs. Une analyse intégrée des travaux de recherche a permis une perspective des résultats à l’aide du cadre de référence pour la prévention et gestion des maladies chroniques et du cadre d’analyse pour les résultats pour la santé, en relation avec les connaissances actuelles sur la problématique. Cette thèse a contribué à l’avancement des connaissances pour la gestion des UPDs en ÉMD incluant le podiatre et a démontré que cette pratique clinique peut avoir des répercussions sur l’UPD et l’AMI. Elle démontre également l’importance d’optimiser la prise en charge ii en ÉMD incluant le podiatre. Elle a proposé l’aspect novateur d’un matériel biomédical, la cellulose phosphorylée avec l’argent ionisé, ayant le potentiel d’être impliqué dans la prise en charge de l’infection locale de l’UPD puisque les résultats préliminaires sur ses capacités antibactériennes, dans les conditions de laboratoire, ont un effet comparable à des produits de même nature actuellement proposés par l’industrie. Somme toute, que ce soit une UPD qui résulte en une AMI ou non, avec ou sans infection, ce qui importe concrètement, c’est d’en diminuer le nombre et de contribuer à la qualité de vie de ces personnes atteinte de diabète. Les professionnels de la santé, dont les podiatres, doivent donc agir selon les meilleurs pratiques en ÉMD et les décideurs doivent mobiliser les ressources nécessaires. / In the context of increasing life expectancy and obesity rates as well as environmental and cultural changes, the prevalence of diabetes is on the rise, as are its inherent complications such as diabetic foot ulceration (DFU), lower extremity amputation (LEA) and higher infection risks. An efficient way to manage these complications is a multidisciplinary team (MDT) approach along with integrated foot care involving several professionals, including the podiatrist. In order to improve health-related outcomes for these persons, the objectives of this thesis are, first, to develop new knowledge to further understand the role of the podiatrist and his interventions, performed alone or in MDT context, in the management of DFU and LEA, and second, to specifically explore the possibility of new material for the prevention of bacterial colonization of UPDs, mainly associated with Staphylococcus aureus. These research projects adopt an integrated approach involving theoretical, practical and experimental domains and uses different methodological approaches such as systematic review with meta-analysis, comparative cohort study and in vitro experimental study. It has led to three scientific articles; the first two specifically address the effects of podiatrist interventions in the MDT approach on health-related outcomes (data on DFUs, LEAs and the usage of healthcare resources) and the last concerns the antibacterial efficacy of a potential material for local infection management. An integrated analysis of the research projects provides perspective on the results through the use of the framework for prevention and management of chronic diseases and the analytical framework for health-related outcomes, in relation with the latest scientific evidences on this issue. This thesis contributes to the advancement of knowledge for the management of DFUs in MDT approach including podiatrists and demonstrates that this type of clinical management can have significant impacts on LEAs, including decreasing rates of major and total LEAs and improvement of healing time and rate of DFUs. It also establishes the importance of optimizing MDT with the podiatrist. Furthermore, it puts forward the potential of an innovative biomedical material, phosphate cellulose fibers with ionic silver, to be involved in the management of local DFU infection, due to its antibacterial properties which, under laboratory conditions, have an effect comparable to similar products currently offered by the industry. In sum, what truly matters is that whether or not a DFU, with or without infection, results in LEA, the aim is to reduce the number of its occurrences and to contribute to the quality of life of the people it affects. Health professionals including podiatrists must therefore act according to best practices in MDT approach and decision-makers must mobilize the necessary resources.