Burnout among the podiatry profession: A survey of podiatrists in Aotearoa New Zealand.

INTRODUCTION: Burnout and occupational stress have not yet been explored within the Aotearoa New Zealand (AoNZ) podiatry workforce despite research suggesting an increased risk among this population. This study aimed to: (i) determine the prevalence and severity of burnout risk and occupational stress among AoNZ podiatrists; (ii) determine the factors associated with burnout risk and occupational stress among AoNZ podiatrists; and (iii) examine the relationship between burnout risk and occupational stress. METHODS: A cross-sectional online survey study was undertaken involving registered podiatrists practicing in AoNZ. Personal and professional demographic characteristics were captured. Participants also completed the Maslach Burnout Inventory (assessing three domains of emotional exhaustion, depersonalisation and personal accomplishment) and the Workplace Stress Scale as measures of burnout risk and occupational stress, respectively. Descriptive statistics, multiple regression analyses and correlation analyses were performed to address the research aims. RESULTS: Responses from 112 AoNZ podiatrists were included in the analyses. High levels of emotional exhaustion were identified in 43.8% of practitioners and were associated with physical activity status, sector of work, working in isolation and work hours (R2 = 0.304, F (8, N = 110) = 5.519, p < 0.001). High levels of depersonalisation were seen in 13.4% of practitioners and were associated with patient caseload and work hours, (R2 = 0.183, F (4, N = 108) = 5.770, p < 0.001). Low levels of personal accomplishment were observed in 8.9% of practitioners and associated with ethnicity, physical activity status and patient caseload, (R2 = 0.152, F (5, N = 106) = 3.577, p < 0.005). A total of 27.7% of practitioners exhibited an overall moderate to high risk of developing burnout. Over a fifth of practitioners exhibited stress at severe or dangerous levels. Stress levels were significantly associated with physical activity status, sector of work and management responsibility, (R2 = 0.282, F (5, N = 47) = 3.218, p = 0.15). A strong positive relationship was found between emotional exhaustion and stress (rho = 0.59, p < 0.001). CONCLUSIONS: The findings reflect a moderate to severe risk of developing burnout within the workforce, with high workloads and collegial isolation constituting the primary modifiable factors driving burnout development. To maintain retention and well-being within the workforce, mitigation strategies must be implemented to address this issue.

The use of antimicrobial dressings for the management of diabetic foot ulcers: A survey of podiatrists in Aotearoa New Zealand.

INTRODUCTION: Diabetic foot ulcers (DFUs) are commonly contaminated with pathogenic organisms and precede most diabetes-related amputations. Antimicrobial dressings are used in the treatment of DFUs; however, recent guidelines do not support their use. There are no data describing the experience of antimicrobial dressing use among podiatrists in Aotearoa New Zealand (AoNZ). This study aimed to (i) determine which antimicrobial dressings podiatrists in AoNZ use for the management of diabetic foot ulcers; and (ii) determine what factors influence AoNZ podiatrists' use of antimicrobial dressing when managing DFUs. METHODS: An anonymous cross-sectional web-based survey was undertaken. Participants were AoNZ registered podiatrists who managed DFUs in their practice. The survey included questions relating to personal and professional demographic characteristics and DFU management and dressing practices. Descriptive statistics were computed to address the research aims. RESULTS: Responses from 43 AoNZ podiatrists were included. Participants reported both cadexomer iodine and silver dressings were the most common antimicrobial dressings used, with honey dressings being the least frequently used. The most influential factors in choosing antimicrobial dressings when managing DFUs were the presence of current infection, ulcer exudate and ability to prevent future infection. The least influential factors in choosing antimicrobial dressings when managing DFUs were patient preferences, cost of dressings and comfort of dressing/pain on removal. CONCLUSIONS: AoNZ podiatrists managing DFUs primarily use antimicrobial dressings containing cadexomer iodine or silver as active ingredients, while lower-cost options, such as honey and povidone iodine are less often used. Current recommendations highlight the lack of evidence to support positive outcomes from any particular antimicrobial dressing over another and advocate that exudate control, comfort and cost be prioritised in decision-making. As cost has been an increasing burden to our healthcare funding, clinicians and organisations may consider this before purchasing and stocking expensive dressings.

Effects of worn and new footwear on plantar pressure in people with gout.

BACKGROUND: In clinical trials, good quality athletic shoes offer short-term improvements (two-months) in foot pain and disability in people with gout, but these improvements are not sustained over time. This may be due to wear and subsequent changes to the structural integrity of the shoe. The aim of this study was to examine the effects of wear on plantar pressures and footwear characteristics in shoes over six-months in people with gout. METHODS: Forty people with gout participated in a cross-sectional repeated measures study. Participants wore a pair of commercially available athletic footwear for six-months. Participants then attended a study visit where the worn footwear was compared with a new pair of the same model and size of footwear. Wear characteristics (upper, midsole, outsole) and plantar pressure were measured in the two footwear conditions. Wear characteristics were analysed using paired t-tests and Fisher's exact tests. Plantar pressure data were analysed using linear mixed models. RESULTS: Increases in medial midsole (P < 0.001), lateral midsole (P < 0.001) and heel midsole (P < 0.001) hardness were observed in the worn shoes. Normal upper wear patterns (P < 0.001) and outsole wear patterns (P < 0.001) were observed in most of the worn shoes. No differences in peak plantar pressures (P < 0.007) were observed between the two footwear conditions. Reduced pressure time integrals at the first metatarsophalangeal joint (P < 0.001), second metatarsophalangeal joint (P < 0.001) and hallux (P = 0.003) were seen in the worn shoes. CONCLUSIONS: The study found signs of wear were observed at the upper, midsole and outsole in the worn footwear after six-months. These changes to the structural properties of the footwear may affect forefoot loading patterns in people with gout.

Evaluation of osteoarthritic features in peripheral joints by ultrasound imaging: A systematic review.

Objective: To determine how structural and inflammatory osteoarthritis (OA) features in peripheral joints are assessed, defined and graded by ultrasound (US) imaging. Design: MEDLINE, CINAHL, Cochrane and SPORTDiscus were systematically searched in March 2021. To be eligible, studies needed to (1) include participants with peripheral joint OA, and (2) used grey scale USI or power Doppler (PD) to assess one or more US features in peripheral joints of the hands and feet. Methodological quality of all included studies was assessed using the Critical Appraisal Skills Program (CASP) tool. Results: A total of 159 citations were identified for screening. Thirty-two articles were included for final analysis and were of good methodological quality. Thirty articles evaluated US features of hand OA and two assessed US OA features in the foot. There were inconsistencies between studies in terms of what US features were assessed, how these features were defined and what grading system was applied to determine degree of osteoarthritic change. Conclusion: The review found inconsistencies in the definition of synovial pathology. Consequently, it is unclear whether synovial pathology is best represented as separate entities or combined as a single domain, termed "synovitis". How OA US features were defined and graded has largely been extrapolated from recommendations originally constructed for populations with rheumatoid arthritis (RA). Given the prognostic value of synovitis for OA progression and the reduced degree of inflammation experienced in OA compared to RA, the validity of applying definitions, grading systems and atlases originally developed for inflammatory arthritis needs consideration.

The footwear experiences of people with gout: a qualitative study.

BACKGROUND: Footwear is an important concern for people with gout, who often describe difficulty finding suitable footwear. Previous studies have identified footwear as a major concern for people with gout. The aim of this study was to carry out an exploration of the footwear experiences of people with gout. METHODS: A qualitative descriptive methodological approach was used for both data collection and analysis. A purposive sampling strategy was adopted with semi-structured interviews conducted, involving 11 participants with gout. Thematic analysis was employed to identify key meanings and patterns within the data. RESULTS: Four key themes derived from interviews included; (1) comfort as a priority, (2) knowing what to buy, (3) knowing what to wear, and (4) challenges of different environments. Footwear comfort was of great importance and linked to characteristics of footwear, with uncomfortable footwear negatively influencing participation in daily activities. The balancing of comfort, appearance and cost, led to less options and reduced confidence when shoe shopping. Footwear use was further limited by the presence of foot tophi and flares, resulting in compromise of footwear choice. Environments such as formal settings and the workplace, led to different footwear requirements. CONCLUSION: People with gout experience problems with footwear which can impact many aspects of life. Health care professionals should consider these footwear-related issues to help facilitate those with gout in finding appropriate footwear.

Effects of a footwear intervention on foot pain and disability in people with gout: a randomised controlled trial.

BACKGROUND: There is limited evidence supporting the long-term effect of a foot care package that includes footwear for people with gout. The aim of this study was to investigate the effectiveness of a footwear intervention on foot pain and disability in people with gout over 6 months. METHODS: Participants with gout (n = 94) were randomly allocated to either a control group (podiatric care and gout education) or footwear intervention group (podiatric care and gout education plus a commercially available athletic shoe). Measurements were undertaken at baseline and 2, 4, and 6 months. Primary outcome was foot pain severity. Secondary outcomes were overall pain, foot impairment/disability, footwear comfort, fit, ease and weight. Data were analysed using repeated measures models. RESULTS: Baseline foot pain scores were low, and no differences in foot pain scores were observed between groups over 6 months (adjusted effect estimate: - 6.7, 95% CI - 16.4 to 2.9, P = 0.17). Improvements between groups in overall pain scores (adjusted effect estimate: - 13.2, 95% CI - 22.2 to - 4.3, P < 0.01) and foot impairment/disability scores (- 4.7, 95% CI - 9.1 to - 0.3, P = 0.04) favouring the footwear intervention were observed at 2 months, but not at 4 or 6 months. Improvements between groups in footwear fit (adjusted effect estimate: - 11.1, 95% CI - 21.1 to - 1.0, P = 0.03), ease (- 13.2, 95% CI - 23.8 to - 2.7, P = 0.01) and weight (- 10.3, 95% CI - 19.8 to - 0.8, P = 0.03) favouring the footwear intervention were also observed over 6 months. Similar improvements were observed for footwear comfort at 2 and 4 months. No other differences in secondary outcomes measured were observed at 6 months (P > 0.05). CONCLUSIONS: Addition of footwear to a foot care package did not improve foot pain in people with gout. Short-term improvements in overall pain and foot impairment/disability and more durable improvements in footwear comfort and fit were observed with the footwear intervention. TRIAL REGISTRATION: ACTRN12614000209695. Registered 27 February 2014, http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12614000209695&isBasic=True.

Footwear interventions for foot pain, function, impairment and disability for people with foot and ankle arthritis: A literature review.

OBJECTIVE: To conduct a literature review on the effectiveness of footwear on foot pain, function, impairment and disability for people with foot and ankle arthritis. METHODS: A search of the electronic databases Scopus, Medline, CINAHL, SportDiscus and the Cochrane Library was undertaken in September 2017. The key inclusion criteria were studies reporting on findings of footwear interventions for people with arthritis with foot pain, function, impairment and/or disability. The Quality Index Tool was used to assess the methodological quality of studies included in the qualitative synthesis. The methodological variation of the included studies was assessed to determine the suitability of meta-analysis and the grading of recommendations, assessment, development and evaluation (GRADE) system. Between and within group effect sizes were calculated using Cohen's d. RESULTS: 1440 studies were identified for screening with 11 studies included in the review. Mean (range) quality scores were 67% (39-96%). The majority of studies investigated rheumatoid arthritis (n = 7), but also included gout (n = 2), and 1st metatarsophalangeal joint osteoarthritis (n = 2). Meta-analysis and GRADE assessment were not deemed appropriated based on methodological variation. Footwear interventions included off-the-shelf footwear, therapeutic footwear and therapeutic footwear with foot orthoses. Key footwear characteristics included cushioning and a wide toe box for rheumatoid arthritis; cushioning, midsole stability and a rocker-sole for gout; and a rocker-sole for 1st metatarsophalangeal joint osteoarthritis. Between group effect sizes for outcomes ranged from 0.01 to 1.26. Footwear interventions were associated with reductions in foot pain, impairment and disability for people with rheumatoid arthritis. Between group differences were more likely to be observed in studies with shorter follow-up periods in people with rheumatoid arthritis (12 weeks). Footwear interventions improved foot pain, function and disability in people with gout and foot pain and function in 1st metatarsophalangeal joint osteoarthritis. Footwear interventions were associated with changes to plantar pressure in people with rheumatoid arthritis, gout and 1st metatarsophalangeal joint osteoarthritis and walking velocity in people with rheumatoid arthritis and gout. CONCLUSION: Footwear interventions are associated with reductions in foot pain, impairment and disability in people with rheumatoid arthritis, improvements to foot pain, function and disability in people with gout and improvements to foot pain and function in people with 1st metatarsophalangeal joint osteoarthritis. Footwear interventions have been shown to reduce plantar pressure rheumatoid arthritis, gout and 1st metatarsophalangeal joint osteoarthritis and improve walking velocity in rheumatoid arthritis and gout.

Fear of falling and foot pain, impairment and disability in rheumatoid arthritis: a case-control study.

Fear of falling, foot pain, impairment and disability are commonly reported in rheumatoid arthritis (RA). However, the relationship between fear of falling and foot pain, impairment and disability has not been investigated in established RA. The aim of the study was to evaluate the relationship between fear of falling and foot pain, walking velocity and foot impairment and disability in women with established RA. A secondary aim was to evaluate differences between fear of falling, foot pain, walking velocity and foot impairment and disability in women with established RA and age- and sex-matched control participants. Twenty-one women with established RA and twenty-one age- and sex-matched controls were assessed for fear of falling, foot pain, foot impairment and disability and walking velocity. Pearson's r-correlations were used to examine relationships between fear of falling and the foot measures. Independent samples t tests evaluated the differences in fear of falling and foot measures between the two groups. In people with RA, significant correlations were found between fear of falling and foot impairment (r = 0.53, p = 0.015), foot disability (r = 0.77, p <0.001) and walking velocity (r = 0.56, p < 0.001). No correlation was found between fear of falling and foot pain (r = 0.36; p = 0.11). Significant differences between cases and control participants were found between fear of falling (p = 0.001), foot impairment (p = 0.004) and foot disability (p < 0.001). Foot impairment and disability relates to fear of falling in women with established RA. A better understanding of fear of falling in people with established RA may contribute to more efficient falls assessments in order to identify at risk individuals.

Gout on CT of the feet: A symmetric arthropathy.

INTRODUCTION: The aim of this study was to assess the distribution of bone erosions in the feet of patients with gout using CT and thereby to test the hypothesis that gout is an asymmetric arthropathy. METHODS: CT scans of both feet were obtained from 25 patients with chronic gout. CT scans were scored for bone erosion using a semi-quantitative method based on the rheumatoid arthritis MRI scoring system (RAMRIS). CT bone erosion was assessed at 22 bones in each foot (total 1,100 bones) by two independent radiologists. Symmetry was assessed by two methods: (i) comparing right and left foot scores for each patient; and (ii) calculating the proportion of paired joints with or without erosions. RESULTS: Observer agreement was excellent (intra-class correlation coefficient 0.92). In the group overall, the difference in scores between the feet was not significant (Student's t-test P = 0.8). In 17 of 25 patients, the difference in erosion scores between the two feet was less than the inter-observer difference. In 24 of 25 patients, the proportion of paired joints was greater than 0.5, indicating symmetric disease. CONCLUSIONS: Erosive disease from gout is, in fact, a symmetric process in our patient group. This finding is contrary to the established view of gout as an asymmetric arthritis and lends new insight into the behaviour of this common disease.

Foot pain, impairment, and disability in patients with acute gout flares: A prospective observational study.

OBJECTIVE: To evaluate the impact of acute gout on foot pain, impairment, and disability. METHODS: This prospective observational study recruited 20 patients with acute gout flares. Patients were recruited from emergency departments, hospital wards, and rheumatology outpatient clinics throughout Auckland, New Zealand. Patients were recruited at the time of the flare (baseline visit) and then reassessed at a followup visit once the acute flare had resolved 6-8 weeks after the initial assessment. Swollen and tender joint counts, C-reactive protein levels, and serum urate levels were recorded at both visits. General and foot-specific outcome measures were also recorded at each visit, including pain visual analog scale, Health Assessment Questionnaire II, Lower Limb Tasks Questionnaire, and Leeds Foot Impact Scale. RESULTS: The foot was affected by acute gout in 17 patients (85%). Objective measures of joint inflammation, including swollen and tender joint counts and C-reactive protein levels, significantly improved at the followup visit compared with the baseline visit. At baseline, high levels of foot pain, impairment, and disability were reported. All patient-reported outcome measures of general and foot-specific musculoskeletal function improved at the followup visit compared with the baseline visit. However, pain, impairment, and disability scores did not entirely normalize after resolution of the acute gout flare. CONCLUSION: Patients with acute gout flares experience severe foot pain, impairment, and disability. These data provide further support for improved management of gout to prevent the consequences of poorly controlled disease.

Footwear characteristics and factors influencing footwear choice in patients with gout.

OBJECTIVE: Gout is associated with foot pain, impairment, and disability. The aim of this study was to assess footwear characteristics and key factors influencing footwear choice in patients with gout. We also wanted to evaluate the relationship between footwear characteristics and foot disability. METHODS: Fifty patients with a history of acute gout were recruited from rheumatology clinics during the summer months. Clinical characteristics, global function, and foot impairment and disability measures were recorded. Footwear characteristics and the factors associated with choice of footwear were identified using validated assessment tools. Suitability of footwear was assessed using predetermined criteria for assessing adequacy of footwear, based on a previous study of foot pain. RESULTS: The patients had moderate to severe foot pain, impairment, and disability. Poor footwear characteristics included poor cushioning, lack of support, lack of stability, and motion control. More than 50% of shoes were ≥12 months old and demonstrated excessive wear patterns. Patients reported comfort (98%), fit (90%), support (90%), and cost (60%) as important factors in choosing their own footwear. No correlation was found between footwear characteristics (length and width) and foot characteristics (foot pain, impairment, and disability). Patients with poor footwear reported higher foot-related impairment and disability. CONCLUSION: Use of poor footwear is common in patients with chronic gout and is associated with foot disability and impairment.