OBJECT: The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. METHODS: A total of 21, 693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. RESULTS: 13, 271 patients had certain kinds of foot problem, accounting for 61.2% of 21, 693 diabetics examined. Of these, fungal foot disease were found in 10, 403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6, 496 (29.9%), onychomycosis in 7, 783 (35.9%), and coexistence was in 3, 883 (17.9%). Foot deformity was in 1, 346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1, 051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5, 486 patients paid a visit to the department of dermatology. Of these, 4, 519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2, 272 males and 2, 247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3, 847 patients (70%) and onychomycosis was proven mycologically in 3, 276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3, 885(70.8%) and tinea pedis was found in 3, 209 (58.5%), most commonly involving the soles. CONCLUSION: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.
Dermatology ; Diabetes Mellitus ; Diabetic Foot ; Diagnosis ; Endocrinology ; Female ; Foot Deformities ; Foot Diseases ; Foot Ulcer ; Foot* ; Humans ; Male ; Mortality ; Nails ; Odds Ratio ; Onychomycosis ; Outpatients ; Physical Examination ; Prevalence* ; Risk Factors ; Skin ; Tinea Pedis ; Ulcer*

As the aging of the foot progresses, the stiffness of the soft tissues, the reduction of the range of motion, the decrease of the muscle strength, and the flattening of foot are manifested. These changes increase the risk of foot pain, the problem of weight distribution and transmission, and the risk of falls, resulting in secondary complications and lowering quality of life. The most common deformities and diseases of the elderly foot are hallux valgus, hammertoes, hallux rigidus, Achilles tendinitis, plantar fasciitis, metatarsalgia, hyperkeratosis, and other deformities of the feet caused by chronic conditions. Systemic diseases that promote these foot problems include diabetes, peripheral nerve damage, repetitive ankle ligament injuries, deformities due to fractures, and obesity. Understanding the mechanisms of aging and the processing of biomechanics in the elderly will enable them to reach a healthy life through appropriate rehabilitation, exercise and educations during aging. In addition, it is necessary to promote the healthy life in elderly by customized exercise, training, and shoes.
Accidental Falls ; Aged ; Aging ; Ankle ; Congenital Abnormalities ; Fasciitis, Plantar ; Flatfoot ; Foot Diseases ; Foot ; Hallux Rigidus ; Hallux Valgus ; Humans ; Ligaments ; Metatarsalgia ; Muscle Strength ; Obesity ; Peripheral Nerves ; Quality of Life ; Range of Motion, Articular ; Rehabilitation ; Shoes ; Tendinopathy

OBJECTIVE: To investigate the effects of physical therapy interventions using strengthening and stretching exercise programs on pain and temporospatial gait parameters in patients with plantar fasciitis (PF).METHODS: Eighty-four patients with PF participated in the study and were randomly assigned to the strengthening or stretching exercise groups. All patients received 8 physical therapy interventions two times per week in the first 4 weeks and performed daily strengthening or stretching exercises three times per day. After 4 weeks, they continued the assigned exercise programs every day for 8 weeks. Pain visual analogue scale (VAS) scores at the worst and in the morning and temporospatial gait parameters were evaluated at the baseline, intermediate of the intervention, end of the intervention, and the first and second month follow-up.RESULTS: There were significant effects of the time on the worst pain, morning pain, cadence, stride time, stride length, total double support, and gait speed, but there was no effect on step width. In addition, the main effect of the group and the interaction effects of the time and the group were not found in any parameters. For intra-group comparisons, there were significant differences in worst pain, morning pain, cadence, and stride time among the assessment times in both groups. For inter-group comparisons, there were no significant differences in all parameters.CONCLUSION: Both strengthening and stretching exercise programs significantly reduced pain and improved gait in patients with PF.
Exercise ; Fasciitis, Plantar ; Follow-Up Studies ; Foot Diseases ; Gait ; Humans ; Muscle Stretching Exercises ; Resistance Training

PURPOSE: The most common cause of plantar ulceration is an excessive plantar pressure in patients with peripheral neuropathy. Foot orthosis and therapeutic footwear have been used to decrease the plantar pressure and prevent the plantar ulceration in in diabetes patients. We investigated whether protective sock with functional insoles reduce plantar pressure while walking in 17 diabetes patients. METHODS: An in-shoe measurement device was used to measure the peak plantar pressure while walking. Peak plantar pressure data were collected while walking under two conditions: 1) wearing diabetic sock and 2) wearing the protective sock with functional insoles. Each subject walked 3 times in 10-m corridor under three conditions, and data were collected in 3 steps in the middle of corridor with in right and left feet, respectively. Pared t-test was used to compare the peak plantar pressures in three plantar areas under these two conditions. RESULTS: The protective sock with functional insoles significantly reduced the peak plantar pressure on the lateral rearfoot, but significantly increased the peak plantar pressure on the middle forefoot, and medial midfoot (p < 0.05). However, there were not significant in medial and lateral forefoot, lateral midfoot, and medial rearfoot between diabetic sock and the protective sock conditions (p>0.05). CONCLUSION: The protective sock with functional insoles reduced plantar pressures in the rearfoot and supported the medial longitudinal arch. However, it is necessary to change the position of metatarsal pad in the insole design of forefoot area to prevent diabetic foot ulceration.
Diabetes Mellitus ; Diabetic Foot ; Foot Orthoses ; Foot Ulcer ; Foot* ; Humans ; Metatarsal Bones ; Peripheral Nervous System Diseases ; Ulcer ; Walking

BACKGROUND: It has been widely accepted that the prevalence of tinea pedis in soldiers may be higher due to their occlusive army boots and communal baths. OBJECTIVE: Our study was designed to investigate the prevalence of tinea pedis in Korean soldiers monthly throughout the year by the ranks of the soldiers and also to verify whether tinea pedis is one of the occupational diseases in Korean soldiers. METHODS: We examined the feet of soldiers in a battalion monthly throughout the year. On those with suspected skin lesions, microscopic examinations along with fungus cultures were performed in July, 1996. RESULTS: Average prevalence of tinea pedis throughout the year was 51.5% on clinical examination. The highest prevalence was 74.0% in August and the lowest in February by 36.7% . The prevalence of tinea pedis by rank was 38.3%(18/47) in the new private group, 61.7%(29/47) in the private group, 84.8%(67/79) in the private 1st class group, 72.4%(55/76) in the corporal group and 70.9%(39/55) in the sergeant group in July, 1996. Dermatophytes were demonstrated microscopically in 59.1%(123/208) of the specimens examined. Cultures were positive in 93 cases, i.e., from 44.7% of those examined. CONCLUSION: The major factor contributing to the highest prevalence of tinea pedis in August among the months of the year seems to be the hot and damp weather conditions(especially in July and August). Considering the fact that the prevalence of tinea pedis in winter season was also higher by 36.7-40.2%, Korean soldiers seem to possess higher risk of tinea pedis due to their tight-fitting army boots. The spread of infection among non-infected soldiers might have resulted from the communal bath and Korean traditional habit of taking-off their shoes in a large dormitory where they sleep together. Moreover, the fact that the prevalence of tinea pedis increases markedly with their ranks suggests that tinea pedis should be considered as an occupational disease among Korean soldiers.
Arthrodermataceae ; Baths ; Foot ; Fungi ; Humans ; Military Personnel* ; Occupational Diseases ; Prevalence* ; Seasons ; Shoes ; Skin ; Tinea Pedis* ; Tinea* ; Weather

The occupational skin diseases in an industry of silk reeling located in Daegu city of Korea were analyzed by inspection through a mass survey for improving the workers' health, November, 1975. The subjects, 177 persons were all females, and were distributed at 18-38 years old. About two thirds were under 25 years old. The mean age was 23.6 years. The incidence of skin diseases was about 53%. It was generally divided into groups; -the epidermic changes of those were most frequent, 47.5%, the allergic reactions were 14.7%, and athlete's foot was only four cases, 2.3%. Most frequent signs of epidermic changes was the wornout nail, 32.3%; and the keratolysis, 28.8%; and the callus, 15.3% were followed in order. Theses were significant in five per cent level between the sections of the silk reeling and the manufacturing;-Allergic reactions and worn-out nail were more frequent in the manufacturing group than the silk reeling, and keratolysis and callus were inverted proportionally. Allergic reactions were occurred within a few months from first entrance time, and it was more frequent in the group exposed to same allergen in the past than the continuing group form first. Most of the appearing sites of theses were hands, and infrequently, it was occurred in the face, neck, trunk, knee and feet. These epidermic changes except allergic phenomena were appeared in the fingers, palmal and dorsal surface of hands frequently contacted. But these changes and allergic reactions were generally combined with two or more kinds.
Adult ; Bony Callus ; Daegu ; Female* ; Fingers ; Foot ; Hand ; Humans ; Hypersensitivity ; Incidence ; Knee ; Korea ; Neck ; Silk* ; Skin Diseases* ; Skin* ; Tinea Pedis

Adult ; Asian Continental Ancestry Group ; Biopsy, Needle ; Disease Progression ; Erythema ; complications ; physiopathology ; Female ; Foot Dermatoses ; complications ; diagnosis ; pathology ; Hand Dermatoses ; complications ; diagnosis ; pathology ; Humans ; Immunohistochemistry ; Pemphigus ; diagnosis ; pathology ; Prognosis ; Pruritus ; complications ; physiopathology ; Rare Diseases ; Singapore ; Syndrome

This study explored the potential utility of gait analysis using a single sensor unit (inertial measurement unit [IMU]) as a simple tool to detect peripheral neuropathy in people with diabetes. Seventeen people (14 men) aged 63±9 years (mean±SD) with diabetic peripheral neuropathy performed a 10-m walk test instrumented with an IMU on the lower back. Compared to a reference healthy control data set (matched by gender, age, and body mass index) both spatiotemporal and gait control variables were different between groups, with walking speed, step time, and SDa (gait control parameter) demonstrating good discriminatory power (receiver operating characteristic area under the curve >0.8). These results provide a proof of principle of this relatively simple approach which, when applied in clinical practice, can detect a signal from those with known diabetes peripheral neuropathy. The technology has the potential to be used both routinely in the clinic and for tele-health applications. Further research should focus on investigating its efficacy as an early indicator of or effectiveness of the management of peripheral neuropathy. This could support the development of interventions to prevent complications such as foot ulceration or Charcot's foot.
Accelerometry ; Dataset ; Diabetes Complications ; Diabetic Neuropathies ; Foot ; Foot Ulcer ; Gait ; Peripheral Nervous System Diseases ; Walking

Diabetic foot diseases which require surgical treatment consists of diabetic foot ulcer, infection and neuropathic arthropathy. Surgical procedures for diabetic foot ulcers and infections such as drainage, debridement, partial foot amputation and major limb amputation are most common procedures and arthodesis with or without deformity correction can be performed for specific diabetic neuropathic arthropathies. Underlying pathomechanism of diabetic foot disease includes diabetic peripheral neuropathy and vasculopathy. Treating physicians should be aware that concomitant complications of long-standing diabetic status such as cardiovascular and renal dysfunction should be addressed to treat intractable diabetic foot diseases successfully. However, with advent of adjuvant treatment which increases vascular supply on ischemic limb disease, proper surgical treatment on diabetic foot disease can prevent or delay major limb amputations, sustaining functional capability of diabetic patients.
Amputation ; Congenital Abnormalities ; Debridement ; Diabetic Foot ; Drainage ; Extremities ; Foot ; Humans ; Peripheral Nervous System Diseases ; Ulcer

Diabetic and nondiabetic vascular diseases cause significant foot problems and it frequently progress to osteomyelitis and amputation. Advances in vascular surgical techniques, including distal arterial bypass via synthetic grafts or autogenous vein grafting have opened the way for higher rate of limb salvage. We have experienced patients with ischemic vascular foot disease and combined skin ulceration and varing degree of soft tissue defect. In three patient with major vessel obstruction, we could preserve limb and avoid major amputation using greater saphenous vein graft with or without microvascular free tissue transfer.
Amputation ; Extremities ; Foot Diseases ; Foot* ; Humans ; Limb Salvage ; Osteomyelitis ; Saphenous Vein ; Skin Ulcer ; Transplants ; Vascular Diseases ; Veins