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The study is to investigate the foot care practices among filarial lymphoedema patients, which is relevant to strengthen the second pillar of the Programme to Eliminate Lymphatic Filariasis (PELF). The patients are drawn randomly from a clinic as well as from the community. After getting verbal consent, each patient was subjected to an in-depth interview by using a structured questionnaire on how she/he dealt with lymphoedema and probed about various foot care practices. Of the six foot care measures, most of the patients are practising one or two measures only. Substantial numbers of patients are practising the washing the affected limb regularly. Though majority use normal footwear, none of the patients use specially made footwear. Other foot care practices like, massaging, elevation and exercising of affected, limb and use of bandage are practised by a few patients. The patients' education and lymphoedema grade had significant influence on number of foot care practices adopted. The present results are not surprising, but disappointing, as a few patients are practising the measures specifically aimed to ameliorate the lymphoedema condition. Though the present study area is covered by the mass drug administration under PELF, no serious attempts are made to alleviate disability and morbidity control. Appropriate care of affected limb at early stage can help in prevention or reversal of the progression of the disease, in addition to decrease in frequency of acute lymphangitis attacks. PELF is one of the functions of primary healthcare (PHC) system and hence, peripheral level health institutions of PHC system including primary health centres, health sub-centres and their health workers should take lead in encouraging the patients to modify their behaviour with foot care practices.
This reminds me of an issue I have. I have an issue with all the time and resources we spend on diabetic foot self care, but we forget about the PVD people (and the above posts reminds me, that those with lympoedema should also be included).
:we forget about the PVD people (and the above posts reminds me, that those with lympoedema should also be included).
I get what your saying, but to be rather an*l and pedantic - lymphatic filariasis/elephantiasis are strictly due to parasitic infections from mosquito borne disease, and sit outside of the vascular diseases group.
There are other tropical diseases that we never talk about (mostly because podiatry is not practiced in the tropics to a large degree), which are equally significant; such as ainhum, Transkei foot, Buruli ulcer and leprosy that rarely get a mention but affect millions in equatorial regions.
I agree though, I think we need to expand our typical thoughts about the 'high-risk foot' to encompass the many other medical conditions that place a foot at risk for significant infections and morbidity.
These conditions are far more devastating than a niggling biomechanical toss caused by overweight middle-class Westerners trying to drop a few kilo's from binging over Xmas. Where is podiatry??
***************************************** Remember, it's just a foot.
I agree we need to encompass more than just diabetics. Where i work we have a current divide in the service on offer. In the area we have control over there are specialist, hospital based diabetic foot clinics and also a High risk clinic. These are staffed by podiatrists who are skilled in these areas plus consultants and nurses. There are also community based high risk clnics which include diabetics, PAD, RHA, Gout, Alcoholics, ETC. These are staffed by pods only but they have direct links with the hospital team.
Podoconiosis or 'endemic non-filarial elephantiasis' is a tropical disease caused by exposure of bare feet to irritant alkaline clay soils. This causes an asymmetrical swelling of the feet and lower limbs due to lymphoedema. Podoconiosis has a curable pre-elephantiasic phase. However, once elephantiasis is established, podoconiosis persists and may cause lifelong disability. The disease is associated with living in low-income countries in the tropics in regions with high altitude and high seasonal rainfall. It is found in areas of tropical Africa, Central and South America and north-west India. In endemic areas, podoconiosis is a considerable public health problem. Social stigmatisation of patients is widespread and economic losses are enormous since it mainly affects the most productive people, sustaining the disease-poverty-disease cycle. Podoconiosis is unique in being an entirely preventable, non-communicable tropical disease with the potential for eradication. Low-cost preventive measures are a simple but effective solution. However, so far it has received little attention from health care policy makers and, until recently, research into the disease has been scarce and the pathogenesis and genetic basis are partly unclear. A better understanding of these aspects may lead to new prevention and treatment opportunities. In the past few years, several projects fighting podoconiosis have been started by non-governmental organisations. In February 2011, the World Health Organisation designated podoconiosis as one of the 20 neglected tropical diseases, marking an important step in the fight against the disease.
Lymphoedema is a progressive condition that can have a marked physical and psychological impact on affected patients and significantly reduce the quality of life. The ulcers on chronic lymphoedema patient, which often also makes it impossible for them to work. If left untreated, tends to progress or worsen. Ulcers in lymphoedema patients, therefore, represent not only a medical but also a psychological problem. The treatment is often regarded as being worse than it actually is. In our study of more than 25 years shows around 10% cases are due to chronic lymphodema. Ulcers of chronic lymphoedema are classified into four stages according to their presentation. Their management depends upon their stage of presentation. Patients with chronic lymphoedema and ulceration require a different approach to treatment. The specific issues associated with managing the patient with lymphoedematous ulceration include, limb shape distortion i.e., elephantiasis, care of the skin creases and folds, and swelling of the toes and fore foot. Stage I ulcers will heal with conservative treatment without any surgical intervention. Stage II ulcers needs debridement of the wound and split-thickness skin grafting. The most difficult to treat are the stage III and IV ulcers, due to associated skin changes and reduced vascularity. These cases need debulking along with excision of the ulcer. In order to prevent recurrence of the ulcer in all the four stages needs prolonged follow-up and limb care.
Development and Validation of a Self-Report Lower-Extremity Lymphedema Screening Questionnaire in Women
Kathleen J. Yost, Andrea L. Cheville, Amy L. Weaver, Mariam Al Hilli and Sean C. Dowdy Physical Therapy May 2013 vol. 93 no. 5 694-703
Background Patient-reported signs and symptoms are often the first indication of clinically relevant lymphedema.
Objective The purpose of this study was to develop and assess the diagnostic accuracy of a screening questionnaire to detect lower-extremity lymphedema (LEL) among normal-weight women and women with obesity.
Design This was a cross-sectional survey study.
Methods The authors reviewed existing questionnaires assessing upper-extremity lymphedema (UEL) for potential questions and worked with content experts to generate new items. A draft questionnaire with 59 items was reviewed by 5 physicians and 5 physical therapists who specialized in lymphedema management and 5 female patients with clinically confirmed secondary LEL. A revised questionnaire with 45 items was administered by mail to 186 women with clinically confirmed LEL (n=116) or UEL (n=70). A total of 99 women (53.2% of 186) completed the mailed survey, and 28 women with lymphedema who were recruited directly in a lymphedema clinic waiting area also completed the survey. A parsimonious subset of items that best discriminated patients with and without LEL was identified using chi-square tests and logistic regression. Sensitivity and specificity for detecting LEL and positive and negative likelihood ratios (LR+, LR−) were estimated for the entire sample and for subsamples defined by obesity (body mass index ≥30 versus <30 kg/m2), which may confound the accurate diagnosis of LEL.
Results Questionnaires were completed by 127 women (LEL group, n=88; UEL group, n=39). A sum of 13 items (score range=0–52) was the most discriminating. Using a cutoff score of ≥5 points, the sensitivity and specificity for detecting LEL among all participants were 95.5% and 86.5%, respectively (LR+=7.1, LR−=0.05), and 94.8% and 76.5%, respectively (LR+=4.0, LR−=0.07), for participants who were obese.
Limitations By enumerating a sample with a high prevalence of LEL, a spectrum bias may have been introduced, which may have affected the accuracy of the screening questionnaire.
Conclusions The brief, 13-item self-report questionnaire is a sensitive and specific tool for detecting clinically relevant LEL among women, including those with a body mass index of ≥30 kg/m2.