https://www.um.edu.mt/library/oar/handle/123456789/87913 2026-04-14T23:37:07Z https://www.um.edu.mt/library/oar/handle/123456789/99156 Title: An investigation of foot morbidity in patients with end stage renal disease on dialysis Abstract: Aim: To determine the prevalence of foot morbidity amongst patients with End Stage Renal Disease on dialysis treatment. Methods: A prospective single centre, non-experimental, non-randomized quantitative time series design was employed. The sample was recruited using convenience sampling. The study was carried out at the Renal Unit, Mater Dei Hospital, Malta. Forty seven patients were recruited (a total of 94 limbs). Baseline data was gathered via an initial consultation with the participant whereby medical reports were also reviewed followed by various noninvasive foot assessments which included: Neurological, Arterial, Biomechanical, and Dermatological Assessments. Participants were assessed twice during the study. At the time of recruitment (Time 0) and after six months (Time 1), the Toe Brachial Pressure Index (TBPI), Spectral Doppler Waveform Analysis, and the Quantitative Sensory Testing (QST) were measured at each visit. Results: The prevalence of foot morbidity was found to be high amongst participants with ESRD on dialysis. 95.74% of participants presented with foot deformities, whilst 76.60% presented with skin and nail conditions. 22% of participants had a history of ulceration, 19% had a history of amputation, 9% had active ulceration, and 7% had history of revascularisation. Findings demonstrated an overall poor foot health and footcare behaviour within this population with 40.43% of participants presenting with inappropriate footwear, 70% did not check feet regularly, 87% did not attend to podiatry appointments, whilst 68% were unable to reach their feet for self-care. The mean TBPI decreased during the study period (6months). Albeit not statistically significant, one should not dismiss the reduction in TBPI which indicates that TBPI decreases with time in this specific cohort. The relationship between the TBPI and duration of dialysis was found to be significant and also compliments the reduction of TBPI with time. Both Diabetes Mellitus and dialysis duration were identified as significant predictors for the reduction in TBPI. Results indicated that for every one month increase in dialysis duration, the TBPI was expected to decrease by 0.013 and that the mean TBPI for patients with DM and ESRD was expected to be 0.1565 less than the mean TBPI of patients with ESRD. Conclusion: This study has shed light on the high prevalence of foot morbidity amongst the cohort of patients with ESRD on dialysis within the renal unit in Malta. This study highlighted the importance of expanding practice by introducing a new podiatry service within the renal unit to provide prompt foot screening, foot care, and foot care education, with the aim to reduce severe foot complications. Indeed, the study recommended that End Stage Renal Disease patients on dialysis should embark on a podiatry screening algorithm as soon as they are diagnosed with this condition and continue to be reviewed and monitored closely within the renal unit to delay and/or prevent severe outcomes. Description: M.Sc.(Melit.) 2021-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/87959 Title: An investigation of forefoot plantar pressures and plantar thermal characteristics in the diabetic foot Abstract: Background: Various studies have been conducted with regards to the various factors that may lead to foot ulceration. As a matter of fact, high plantar pressures during walking and high skin temperature contribute to the development of foot ulcers and foot ulcer recurrence (Fernando, et al., 2016). However, although these two modalities are being increasingly used in clinical practice, these two modalities are invariably investigated separately. There is currently a research gap, with few studies investigating the relation of these two emerging modalities together, to investigate whether one affects the other. Aim: To determine whether there is a relationship between forefoot plantar pressures and plantar thermal characteristics in the diabetic foot. Methods: A prospective, quantitative non-experimental study was conducted. Forty-eight participants were divided into four groups namely Group A (Healthy Adults), Group B (Healthy Diabetics), Group C (Participants with Peripheral Arterial Disease) and Group D (Participants with Neuroischaemia). For each participant in each individual group, both feet were analysed, thus a total of 96 limbs were investigated. Foot pressure mapping utilizing the 2-step protocol was employed to obtain the peak plantar pressure. Thermographic temperatures of the plantar aspect of the foot were also recorded following 15 minutes of moderate exercise. For both modalities, five specified regions of interests were taken into consideration (Hallux, 1st MPJ, 2nd to 4th MPJ, 5th MPH and Heel). Results from both measures were then related together. Results: A significant relation (p <0.05), in most cases was noted between plantar pressures and plantar infrared temperatures and this was further confirmed when all the 96 limbs, 24 limbs from each respective group, were assessed together (p=0.00). Furthermore, the scatter plot diagrams all followed an uphill trend and the data points where clustered close to the regression line, indicating that a positive correlation co-efficient is present. In addition, plantar pressures and plantar infrared temperatures exhibited in the complications group were significantly higher than those of the healthy group. Conclusion: Results from this study affirmed that in most cases there is a strong correlation between plantar pressure and plantar infrared temperatures at the regions of interest, implying that an increase in plantar foot pressures will result in higher foot temperatures. Moreover, plantar pressures and plantar infrared temperatures exhibited in the complications group are significantly higher than those of the healthy group. Both these modalities, illustrate an important transfer from subjective to objective evaluation of the high-risk patient and this study acts as a red flag to start appropriate podiatric care long. Description: M.Sc.(Melit.) 2021-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/87958 Title: Gait evaluation in children with type 1 diabetes Abstract: Background: Diabetic foot problems are one of the most feared complications of diabetes (DM). Foot pathologies in children and adolescents who live with Type 1 DM (T1DM) are not uncommon and more so when these children become adults. However; there is a lack of studies investigating whether there are bio-mechanical alterations in the pediatric patients living with T1DM. It is also unknown whether T1DM affects the child’s foot structurally. Few studies have investigated bio-mechanical foot abnormalities in the diabetic child through motion capture analysis. Gait analysis provides an objective and quantitative evaluation, which improves the understanding of causes of gait abnormalities and guides treatment. Aims & Objectives: The main aim of this study was to determine if children aged between 10-16 years with insulin-dependent diabetes have altered foot type pathology and altered gait parameters when compared with children aged 10-16 years who do not live with any medical conditions. The objectives were to analyze any possible differences in foot type and foot deformities through a clinical biomechanical examination in children aged between 10-16 years old who live with and without Type 1 Diabetes Mellitus and to analyze gait via motion capture technology in these same children. Design and Methods: This quantitative research study employed a non-experimental, prospective comparative study. Thirty-four (ɳ=34) participants were recruited and divided into Group A, healthy children (ɳ=16) and Group B (ɳ=18), T1DM children, with children in both groups between the ages of 10-16 years. All participants underwent a thorough dermatological and biomechanical examinations. This was followed by motion capture gait analysis using the Oxford Foot Model in order to investigate foot segment motion. Results: T1DM children demonstrated more dermatological lesions such as hyperkeratotic lesions (33.3%) and in-growing toenails (22%) and structural foot abnormalities such as claw toes (33.3%) and hammer toes (22.2%) and hallux abducto valgus (11.1%) when compared to their healthy counterparts. 72.2% of T1DM children live with a pronated foot type as compared to 50% in heathy children. The results from the gait analysis utilizing the Oxford Foot Model indicate that there is a significant difference between healthy children and T1DMchildren at the hindfoot to tibia angle i.e. ankle dorsiflexion/plantarflexion at heel strike and toe-off, suggesting limited ankle joint motion. Conclusion: From the data obtained indicates that T1DM children have a higher incidence of structural foot pathology than non-diabetic children possibly associated with limited sagittal plane movement at the ankle joint. Thus; they have a need for regular podiatric care to assess, examine, diagnose and possibly manage these possible pathologies at an early stage in order to attempt to reduce their risk of more significant foot problems with DM when they reach their adult life. Description: M.Sc.(Melit.) 2021-01-01T00:00:00Z