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Interesting paper "in press" with the journal Gait and Posture :
Balanowski KR, Flynn LM. Effect of painful keratoses debridement on foot pain, balance and function in older adults. Gait and Posture 2005 (in press).
Background: Painful feet in older people can detrimentally affect balance and are a risk factor for falls. Pain is often associated with plantar hyperkeratoses, which are easily treated by podiatrists. Currently, there is no data defining the effect this treatment has on balance or functional ability. Objective: To determine the effects of scalpel debridement of painful plantar hyperkeratoses on pain, balance and functional ability in older people aged 65 years and over. Subjects: Nineteen men and women aged 65–84 years (mean age 72, standard deviation 5.6). Methods: Pain resulting from plantar hyperkeratoses was measured using a visual analogue scale. Static balance and functional ability were measured using tests of postural sway, co-ordinated stability and timed walking and stepping tests. Painful plantar hyperkeratoses were debrided with a scalpel then all tests were repeated, immediately and 7 days later. Results: Following scalpel debridement, pain levels (sensory and afferent) were significantly reduced (P < 0.0001) and functional ability was significantly increased (P < 0.0001). There was no change in static balance ability. One week after debridement the improved performance in functional ability tests was maintained. Conclusions: Debridement of painful plantar hyperkeratoses reduces pain and improves functional ability in older people. Its effect on static balance was inconclusive.
Gait and Posture has a large backlog of papers, so it will be some time before this paper is actually published. However, those with access to ScienceDirect will be able to download the prepublication version.
It would be interesting to see what happens after a longer follow up period.
In our study published in the British Journal of Podiatry in May 2005 pain scores at six weeks following treatment showed no statistically significant difference from the pain scores taken immediately prior-to scalpel debridement (p>0.05). This means that the subjects who received debridement were no better off in terms of perceived pain than when they first came in for their initial assessment. Of greater concern, is that almost one third of the subjects (32.5%) in this group reported higher pain levels at six weeks post-scalpel debridement than they had reported prior to treatment. Previously, Colagiuri et al. have reported that the appearance of nearly 25% of calluses deteriorated with scalpel debridement. Does this mean that functional ability would deteriorate in these individuals also?