2015 CFPM WINTER GETAWAY SEMINAR

Mike Potter

A summary of The Journal of Foot and Ankle

Research (JFAR) papers and implications for

clinical practice

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

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]*

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 28782 ]*

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]*

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]*

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 all-

time accesses 6629 ]*

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]**

LAST 12 MONTHS #2

Interventions for increasing ankle joint

dorsiflexion: a systematic review and meta-

analysis

Rebekah Young, Sheree Nix, Aaron Wholohan,

Rachel Bradhurst, Lloyd Reed

JFAR 2013, 6:46 (14 November 2013)

[Number of accesses last 12 months 7290]**

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]**

LAST 12 MONTHS #4

A comparison of gait biomechanics of flip-

flops, 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]**

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 all-time accesses last 30days 798 ]***

MOST ACCESSED JFAR PAPERS

As of 16th February 2015:

*Number of all-time accesses:

**Number last 12 months

***Number last 30 days

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.

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:

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.

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.

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)

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.

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).

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.

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.

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)

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.

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.

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.

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)

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)

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.

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.