What are the latest developments in foot care research?

Latest Developments in Foot Care Research

The most recent research in foot care emphasizes an interprofessional approach facilitated by podiatrists for individuals with high-risk feet, particularly focusing on prevention strategies for diabetic foot ulcers. 1

Risk Assessment and Prevention

Identifying At-Risk Feet

• Comprehensive foot examination should be performed annually for all people with diabetes and more frequently for those at higher risk 1
• Risk factors requiring special attention include:
  • Peripheral neuropathy/loss of protective sensation (LOPS)
  • Peripheral arterial disease (PAD)
  • Foot deformities (bunions, hammertoes, Charcot foot)
  • History of prior ulceration or amputation
  • Smoking
  • Retinopathy and nephropathy 1

Assessment Techniques

• 10-g monofilament test plus at least one other neurological assessment tool (pinprick, temperature perception, ankle reflexes, or vibration testing with 128-Hz tuning fork) to detect LOPS 1
• Assessment of lower-extremity pulses, capillary refill time, rubor on dependency, pallor on elevation, and venous filling time for PAD screening 1
• Individuals with decreased or absent pedal pulses should be referred for ankle-brachial index with toe pressures 1

Preventive Interventions

Footwear Recommendations

• Well-fitted walking shoes or athletic shoes that cushion the feet and redistribute pressure for people with neuropathy or increased plantar pressures 1
• Extra wide or deep shoes for people with bony deformities 1
• Custom-molded shoes for people with extreme bony deformities that cannot be accommodated with commercial therapeutic footwear 1
• Specialized therapeutic footwear is strongly recommended for people with diabetes at high risk for ulceration 1

Self-Care Education

• Daily foot inspection using palpation or visual inspection with an unbreakable mirror 1
• Proper nail and skin care 1
• Breaking in new shoes gradually to minimize blisters and ulcers 1
• Family member assistance for patients with visual difficulties, physical constraints, or cognitive problems 1

Advanced Prevention Strategies

• Foot-ankle exercise programs show promising benefits for reducing risk factors for ulceration 1
• Daily foot skin temperature measurements with preventative actions when hot spots are detected (>2°C difference between affected and unaffected foot) 2
• Callus debridement by foot care specialists to reduce pressure points 1

Treatment of Foot Ulcers

First-Line Therapies

• Surgical debridement, pressure offloading, and treating lower extremity ischemia and foot infections 2
• Multidisciplinary care involving podiatrists, infectious disease specialists, and vascular surgeons in collaboration with primary care clinicians 2

Advanced Wound Healing Options

• For chronic diabetic foot ulcers that have failed standard care, consider adjunctive treatments such as:
  • Negative-pressure wound therapy
  • Placental membranes
  • Bioengineered skin substitutes
  • Acellular matrices
  • Autologous fibrin and leukocyte platelet patches
  • Topical oxygen therapy 1

Antimicrobial Considerations

• Most diabetic foot infections are polymicrobial with aerobic gram-positive cocci predominating 1
• Emerging concern about fluconazole-resistant Candida infections in diabetic foot ulcers (9.3% resistance rate in recent studies) 3
• Wounds without evidence of soft tissue or bone infection do not require antibiotic therapy 1

Emerging Research Areas

Psychological Interventions

• Development of psychological interventions to support psychosocial wellbeing and help prevent diabetic foot ulceration is an emerging area of research 1
• These interventions aim to address the psychological aspects of foot care adherence and self-management 1

Quality Improvement Initiatives

• Development of surveillance systems (registries, pathways) to monitor foot health outcomes 1
• Implementation of multidisciplinary foot care teams has been shown to reduce amputation rates 1

Long-Term Outcomes and Challenges

• Recurrence rates after healing are estimated at 42% at 1 year and 65% at 5 years 2
• The 5-year mortality rate for individuals with diabetic foot ulcers is approximately 30%, exceeding 70% for those with major amputation 2
• Disparities exist in foot ulcer and amputation rates among racial/ethnic groups and socioeconomic levels 2

Prevention of Recurrence

• Evidence supports integrated foot care that includes professional foot treatment, therapeutic footwear, and patient education 4
• Surgical interventions can be effective in selected patients, though the evidence base is limited 4

By implementing these evidence-based approaches to foot care, particularly for high-risk individuals, significant reductions in foot ulceration, infection, hospitalization, and lower-extremity amputation can be achieved 1.