Relationship between hand-foot skin reaction and external force on patients with hepatocellular carcinoma: A cohort study.

PURPOSE: Hand-foot skin reaction (HFSR), a side effect of tyrosine kinase inhibitor (TKI) treatment, makes it difficult to walk and perform daily activities because of pain in the limbs. HFSR occurs predominantly in the sites where external forces (pressure and shear stress) are applied. This study aimed to determine whether pressure or shear stress induces the occurrence of HFSR. METHODS: This cohort study was conducted in patients who received TKI treatment for hepatocellular carcinoma. The external forces applied to the sole of the patients' foot while walking was measured, and its association with the occurrence of HFSR was examined. The degree of HFSR was assessed by the patient's response during the examination and by photographs of their feet. The patients' feet were divided into low (grade <2) or high (grade ≥2) HFSR foot group, and the differences in external forces between the groups were analyzed using t-test and Cox hazard analysis. RESULTS: Analysis of the feet of 55 study participants (n = 110) showed no significant difference between the groups on t-test (p ≥ 0.05), however, Cox hazard analysis showed an increased risk of HFSR with higher peak shear stress values at the fifth metatarsal head (hazard ratio = 1.01, p = 0.047; 95% confidence interval = 1.00-1.02). CONCLUSION: Shear stress is possibly related to HFSR occurrence. Nurses should assess whether patients' shoes fit their feet before initiating TKI treatment. They should instruct patients to wear shoes that are fit of both diameter and width for their feet.

Factors affecting activities of daily living among patients with Wilson disease.

Wilson disease (WD) is a congenital copper metabolism disorder with various manifestations and can be treated with oral medication. This study examined the factors related to decline in activities of daily living (ADL) in patients with WD as research in this area remains limited. We enrolled 308 patients with WD, including patients who participated in a national survey and those who sought cares at the Department of Pediatrics, Toho University Ohashi Medical Center, from 2016 to 2017. We analyzed the association between ADL decline and factors including age at diagnosis, period from diagnosis to survey, hepatic symptoms, neurological signs, and psychiatric presentation at diagnosis. The relative risks (RRs) for ADL decline were estimated for each factor using multivariate modified Poisson regression analysis. Overall, 97 out of 308 (31.5%) patients experienced ADL decline. After adjusting for explanatory variables, regression analysis revealed that factors significantly associated with ADL decline were a period of ≥20 years from diagnosis to survey (adjusted RR = 2.34, 95% confidence interval [CI]: 1.47-3.74), hepatic symptoms with splenomegaly (adjusted RR = 2.57, 95% CI: 1.26-5.24), mild neurological signs (adjusted RR = 3.20, 95% CI: 1.96-5.23), and severe neurological signs (adjusted RR = 3.63, 95% CI: 2.28-5.77). Neurological signs, hepatic symptoms with splenomegaly, and a period of 20 years from diagnosis to survey are associated with ADL decline. Thus, careful assessment of patients for these factors is necessary, and these findings may guide future efforts to improve patient prognosis.

Quality of life in Werner syndrome and associated subjective foot/ankle symptoms: A cross-sectional survey.

AIM: The aims of this study were to assess the general quality of life and foot/ankle health-related quality of life among subjects with Werner syndrome (WS) and to determine subjective foot/ankle symptoms associated with quality of life. METHODS: Using a questionnaire survey, patients were asked to provide information on age, sex and presence of subjective symptoms and complete both the 36-Item Short Form Health Survey (SF-36) questionnaire and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Statistical analyses were performed using Student's t-test, the Mann-Whitney U test, Fisher's exact test and Spearman's rank correlation. RESULTS: Data from 12 patients with an average age of 54 ± 8.6 years were analyzed. The mean SF-36 score for the domain of physical functioning was 21.2; for role-physical function, 32.6; for bodily pain, 38.5; for general health, 34.4; for vitality, 44.8; for social function, 38.5; for role-emotional function and for mental health, 46.7. The mean mental component summary was as high as the national standard, but it was low in men. The mean SAFE-Q scores were also low. Patients with ulcers had significantly more pain and low general health perception. As compared with the national standard, the role/social component score was not low, and there was a correlation in most domains of the SAFE-Q. CONCLUSION: In WS, the general health-related quality of life was low overall in the physical domain and low only in men for the mental domain, whereas it was low in the social domain when foot/ankle health-related quality of life was low. Geriatr Gerontol Int 2023; 23: 188-193.

Formal pump heel height affects the external force exerted on the foot during normal walking.

Forefoot pain, hallux valgus, shoe sore, flat foot, and calluses are among the common foot problems encountered by high heel wearers. This study aimed to investigate the external forces associated with shoe sore and callus while wearing formal heel shoes. The external force on the 1st, 2nd, and 5th metatarsal heads and heel center was measured using the ShokacChip. Women were asked to wear pumps with four heel heights (10, 30, 55, and 80 mm) and walk 15 m twice. Thirty-five women were included. The data of two participants were excluded due to sensor fault. With higher heels, normal stress (pressure) was significantly stronger on the inside of the forefoot and significantly weaker on the outside. Shear stress did not always increase or decrease proportionally with respect to heel height. SPR-i of the forefoot associated with callus formation was minimal in the 30-mm heel. Clinical Relevance- This study aims to provide a guide for shoe selection in order to avoid foot troubles in women.

Study of Alarm Threshold for Assumed Nasogastric Tube Self-removal Action Using a Contact Sensor System.

Physical restraints negatively impact the physical, mental, and social well-being of patients. However, elderly people with dementia are often physically restrained by preventing nasogastric tube (NG tube) self-removal. This study aimed to examine alarm threshold settings limited to the actions that the subject makes contact with the NG tube out of feeling uneasy for the NG tube (assumed self-removal actions) using a contact sensor system in order to achieve non-physical restraint. In this study, subjects with experience in caring for older people with dementia were required to perform an assumed self-removal action along with 15 kinds of non-self-removal actions, while we observed the contact detection and measured the voltage. The alarm thresholds for the assumed self-removal action were examined from the ROC curve using the voltage zero time and the number of times the voltage was up and down during each action as a variable. The system presented in this study allowed us to reduce the false alarm rate from 23.3% to 8.5%. Furthermore, we used this alarm threshold to verify the data of three new subjects, observing a false alarm rate of 0.0%. Our future research would focus on investigating and evaluating elderly with dementia using the alarm threshold of the assumed self-removal action that we examined. In addition, we would use ICT to link contact detection with the nurse call system. Clinical Relevance- In this study, we examined the alarm threshold limited to the expected self-removal action using a contact sensor system. We showed that it is possible to detect the NG tube self-removal with few false alarms.

Long-term body weight change assessed by non-contact load cells under the bed in older people with and without eating assistance: a preliminary study.

Utilizing automatic daily body weight (BW) measurements may be helpful for assessing nutritional status and detecting underlying diseases particularly in older people who require nursing care. This preliminary study aimed to verify effectiveness of eating assistance for maintaining BW in older people using a contact-free load cells under the bed (Bed Sensor System: BSS). BW was measured every night for 3 months in eight nursing home older people with severe cognitive and physical dysfunctions. Body composition of the subject's trunk and each limb was measured using a segmented multi-frequency bioelectrical impedance analyzer (BIA). A monthly BW loss was estimated as a slope of linear regression of the daily BW plot. BSS successfully measured daily BW for the study period in all participants. The 4 residents with eating assistance gained slightly more weight, while the 4 residents without eating assistance lost weight. There was a significant difference between the two groups in the monthly BW change (- 0.79 ± 0.51 kg/month versus 0.20 ± 0.49 kg/month, P = 0.030). None of the BIA-derived parameters was associated with the monthly BW change. BSS revealed effectiveness of eating assistance to maintain BW in nursing home residents with severe cognitive and physical dysfunctions.

Examination of a contact detection sensor to prevent self-removal of peripheral intravenous catheters.

If patients are at risk of self-removal of a catheter, it is necessary to check the condition of the catheter frequently. If this is the only way to prevent self-removal, physical restraint of the patient is required. Furthermore, it is currently necessary to reduce human-to-human contact to prevent COVID-19 infection. Therefore, the development of a sensor system to prevent self-removal of a catheter and reduce human-to-human contact is urgent. The purpose of this study is to examine a sensor system that detects the contact of a patient's hand to a peripheral intravenous catheter in order to prevent self-removal in patients with dementia. This study analyzes the use of a capacitance sensor and an energization sensor to detect the contact of a patient's hand to a catheter. Additionally, the time required from the start of peeling the sensor sheet to the removal of the needle was measured. As the results, the capacitance sensor was difficult to use in a clinical setting because the connection between the seat and cable could be unstable depending on the condition of the connections. The energization sensor was able to recognize the contact of a hand to the catheter by detecting its contact with the sensor. It took at least 28 seconds from detection of the hand contact to the beginning of needle removal. Therefore, it is possible for the caregiver to visit the patient's bedside and stop the self-removal when the sensor sheet detects hand contact. This study is the first step in developing the system that prevents self-removal by detecting hand contact and requires several more steps for clinical use. In the future, we will conduct surveys on more subjects and clinical trials on elderly with dementia to examine accuracy, precision, and repeatability. Using the energization sensor, a self-removal prevention system for dementia patients will be further developed.Clinical Relevance- Developing this self-removal prevention system in the future will allow many dementia patients to no longer be physically restrained, and it will make it possible to remotely detect their actions to prevent self-removal while also minimizing the risk of COVID-19 infection.

Gait due to difference in Intravenous pole position on the healthy participants.

INTRODUCTION: The gait while using an intravenous (IV) pole is close to the gait of the elderly and fallers. Additionally, one survey has reported that the diagonal position is optimal for transporting an IV pole with a light load. However, in clinical practice, carrying a heavier load may be possible. Therefore, this study clarifies the optimum operation position using an IV pole with a weight closer to that in actual clinical practice. METHOD: Using image analysis software, we investigated several variables indicating gait, such as stride length. Participants walk with an IV pole in three ways: sideways, in front, and diagonally. We investigated two types of IV pole loads, which are 0.5 kg and 5.0 kg. RESULTS AND DISCUSSION: In 0.5-kg settings, the sideways position is a way to suppress the narrowing of the heel-floor angle. No significant difference in the subjective appraisals was observed between the sideways and diagonal positions. In addition, the sideways position is as optimum as the diagonal position. In 5.0-kg settings, only the sideways position suppressed the narrowing of the step length. Therefore, the sideways position is optimal. However, the participants' impressions suggested that arm strength is required for the sideways position. If a patient has weak arms and cannot maintain the sideways position, the patient may choose the diagonal position. Moreover, the front position is the way to hold the trunk most forward. However, there is a possibility that it is easy for a specific person, such as a rollator user, to choose. Therefore, further investigate of the optimum operation position depending on the walking abilities is needed. CONCLUSION: It was suggested that the sideways position is optimal for walking with an IV pole when transporting with a total load of approximately 5.0 kg.Clinical Relevance- The results of this study help to prevent people from gait like fallers and the elderly when using IV poles in clinical settings.

Evaluation of bowel preparation before colonoscopy by ultrasonographic monitoring of colonic fecal retention: a case series.

AIMS: While bowel preparation for colonoscopy is the key to successful examination, taking laxatives and showing stools to others causes both physical and mental distress to the patient. Thus, an alternative method to evaluation bowel preparation is necessary. In the current study, we studied the colonic fecal retention by ultrasonography (US) and examined the US finding which reflected completion of BP. MATERIAL AND METHODS: The subjects were outpatients who underwent colonoscopy. This report summarizes the ultrasonographic images of patients who underwent multiple US examinations for all five sites of the colon just before, during, and immediately after bowel preparation. According to the standard protocol, the patients took 2 L of polyethylene glycol-ascorbic acid as a laxative, which was discontinued when the nurse visually judged the stool to be clear. RESULTS: Seven patients in their 50s-80s, none of whom were unable to complete a colonoscopy due to residual feces were included in study. Following bowel preparation, the US images showed anechoic areas with haustration in four or all five areas of the colon. Three of the seven patients received low-dose laxatives (1.1-1.2 L); all three had watery stools in three or more colon areas and none of them were constipated at the time of taking 1 L of laxatives. CONCLUSIONS: Completion of bowel preparation can be assessed by the observation of anechoic areas with haustration in multiple colonic sites by ultrasonography.

Factors Associated with Callus Formation in the Plantar Region through Gait Measurement in Patients with Diabetic Neuropathy: An Observational Case-Control Study.

Callus has been identified as a risk factor leading to severe diabetic foot ulcer; thus, it is necessary to prevent its formation. Callus formation under the first, second, and fifth metatarsal heads (MTHs) is associated with external forces (pressure and shear stress) during walking. However, the gait factors increasing the external forces remain undetermined. Thus, this study aims to identify the factors increasing the external forces to prevent callus formation. In 59 patients with diabetic neuropathy wearing their usual shoes, the external forces, and the lower extremity joint angles were measured using MEMS force sensors and motion sensors. The external forces and their relationship with the lower extremity joint angles and footwear size were determined. Risk factors causing high external forces on the first MTH included small flexion of the knee joint (p = 0.015) and large ankle pronation motion (p = 0.034) to obtain propulsion. For the second MTH, wearing excessively long footwear was identified (p = 0.026). For the fifth MTH, high external force was related to tight width footwear (p = 0.005). An effective intervention for preventing callus formation for the first MTH would involve assisting the push-off foot motion using rocker-sole footwear or gait training. For the second and fifth MTHs, wearing appropriate size footwear would be effective.

Impact of nurse-assisted patient turning at different sleep stages on the quality of subsequent sleep.

BACKGROUND: Nursing care performed during sleep, including nurse-assisted patient turning, is one of the factors that deteriorates sleep quality but is necessary for pressure ulcer prevention. Thus, it is important to determine when nurseassisted patient turning has the least impact on sleep quality. AIM: The aim of this study was to clarify the impact of nurseassisted patient turning at different sleep stages and to determine the optimal timing of this aspect during sleep. METHODS: The experiment, which consisted of healthy men in their 20s and 30s, was performed over four successive nights per subject. The first night was dedicated to environment adaptation, and the 2nd to the 4th nights were randomly assigned for shallow sleep intervention, deep sleep intervention, and non-intervention. On the intervention day, nurse-assisted patient turning was conducted twice. Overnight sleep conditions were measured by polysomnography (PSG). The PSG waveform transmitted to a tablet was analyzed in real time to determine the stage of sleep. The patient was turned when he entered the planned stage of sleep. RESULTS: The study analyzed fourteen (14) subjects. Shallow sleep time, deep sleep time, and sleep resumption time after nurse-assisted patient turning were compared among the three groups of non-intervention day, shallow sleep intervention day and deep sleep intervention day. There was no significant difference in the shallow and deep sleep time among the three groups. However, sleep resumption time after nurse-assisted patient turning was significantly shorter on the deep sleep intervention day than on the shallow sleep intervention day (p = textbf 0.033). CONCLUSIONS: This study has novelty in examining the impact of nurse-assisted patient turning performed at different sleep stages on subsequent sleep using objective indicators. The study suggested that a deep sleep state is the optimal timing of nurseassisted patient turning due to the short time to sleep resumption.

Examination of the Effect of Suitable Size of Shoes under the Second Metatarsal Head and Width of Shoes under the Fifth Metatarsal Head for the Prevention of Callus Formation in Healthy Young Women.

Excessive pressure and shear stress while walking cause a risk of callus formation, which eventually causes foot ulcers in patients with diabetes mellitus. Callus under the second metatarsal head (MTH) has been associated with increased shear stress/pressure ratios (SPR). Callus under the fifth MTH has been associated with increased peak shear stress (PSS). The purpose of this study is to examine whether the effect of the suitable size and width of shoes prevents diabetic foot ulcers under the second and fifth MTH. We measured the pressure and shear stress by testing three kinds of sizes and two types of width of shoes. Significant difference was not observed in the SPR under the second MTH among different sizes of shoes. However, the pressure and shear stress were significantly lower when putting on shoes of fit size compared with larger sizes. The PSS under the fifth MTH was significantly smaller when putting on shoes of fit width compared with those of narrow width. Wearing shoes of fit size and width has the potential to prevent callus formation by reducing the pressure and shear stress constituting SPR under the second MTH and PSS under the fifth MTH.

The external force associated with callus formation under the first metatarsal head is reduced by wearing rocker sole shoes.

INTRODUCTION: Callus is one of the main causes of diabetic foot ulcers. Therefore, preventing callus formation is very important. In a previous study, it was clarified that callus formation under the first metatarsal head (MTH) is associated with high shear stress time integral/pressure time integral (SPR-i). another study, it was clarified that rocker sole shoes are effective in reducing peak pressure under the first MTH. Therefore, we hypothesized that rocker sole shoes reduce SPR-i under the first MTH. This study aimed to clarify the effect of rocker sole shoes for external forces and leg motions in comparison with that of the normal sole shoes. METHODS: In-shoe external forces and leg motions were measured during walking wearing the normal sole shoes or the rocker sole shoes in healthy participants. As the external forces, the peak plantar pressure (PP), pressure time integral (PI), peak shear stress (PSS), and shear stress integral (SSI) of each gait cycle were calculated. Additionally, shear stress-pressure ratios (SPR) were calculated by dividing shear stress by pressure; concretely, peak values (SPR-p) and time integral values (SPR-i). As the leg motion, hip and knee joint motions were analyzed for the axis of flexion- extension. Three axes of ankle joint motion (inversion-eversion, plantar flexion-dorsiflexion, and adduction-abduction) were analyzed. RESULTS AND DISCUSSION: Six participants attended, and twelve feet were analyzed. When wearing the rocker sole shoes, the SPR-i under the first MTH was significantly smaller than when wearing the normal sole shoes. The SPR-i higher than 0.60 is associated with callus formation under the first MTH. In three of five feet with callus, SPR-i exceeded 0.60 in the normal sole shoes. The SPR-i of all three feet became smaller than 0.60 when wearing the rocker sole shoes. Although the knee (flexion-extension) and ankle (plantar flexion-dorsiflexion) joint motion became smaller when wearing the rocker sole shoes, there was no significant difference in walking speed. It is considered that propulsion was maintained by the push-off support provided by rocker sole shoes. CONCLUSION: It was suggested that rocker sole shoes are effective preventing callus formation under the first MTH.

The Association between Tinea Pedis and Feet-Washing Behavior in Patients with Diabetes: A Cross-sectional Study.

OBJECTIVES: To examine the correlations between elements of feet-washing behavior, presence of tinea pedis (TP), and patients' background characteristics in order to identify a concrete intervention method to prevent TP. DESIGN AND PARTICIPANTS: A cross-sectional study of 30 patients with diabetes (16 with TP) who were admitted to or visited the university hospital. MAIN OUTCOME MEASURES: The presence of TP was confirmed by the detection of dermatophytes by direct microscopy. Data on elements of feet-washing behavior, such as scrubbing between the toes, were collected by observing recorded videos of participants normally washing their feet as they do at home. The patients' background characteristics included demographic data; diabetes-related factors; patient knowledge regarding diabetes, foot problems, and TP prevention; purpose for feet washing; and any difficulties in feet washing. MAIN RESULTS: The number of times patients scrubbed between their toes while washing with soap was significantly lower in patients with TP (odds ratio, 0.95; P = .036; with a cutoff value of 35 times) and those who had difficulty in reaching their feet with their hands (B = -14.42, P = .041). CONCLUSIONS: An effective foot-washing protocol should include specific instructions for patients to scrub between their toes at least 35 times in all 8 spaces while washing with soap. Appropriate advice is also needed for individuals who have difficulty reaching their feet with their hands. Education about appropriate foot-washing behavior may potentially prevent TP.

Thermographic findings in a case of type 2 diabetes with foot ulcer due to callus deterioration.

ABSTRACT: A number of studies have reported the usefulness of monitoring skin temperature at local points in reducing the risk of ulceration. Thermography has the advantage of being able to visualize morphological temperature distribution. We reported that inflammation was detected by thermography in 10% of diabetes mellitus (DM) patients with foot calluses, and the area in which increased skin temperature was observed was limited to the callus. However, no reports have described thermographic findings of calluses deteriorating into foot ulcers. We report a case monitoring the skin temperature distribution using thermography, which might be useful for predicting ulceration. CASE: A 53-year-old male patient, diagnosed with type 2 DM, was treated with insulin therapy. The duration of DM was 4 years. He was also diagnosed with dyslipidemia and hypertension. Using thermography, the skin temperature was evaluated in the patient with calluses on the 5th metatarsal heads. Areas of increased skin temperature were observed, involving not only the callused part, but also the plantar arch. We shaved his calluses once a month and explained the importance of his therapeutic shoes to prevent the ulcers. After 43 months, an ulcer developed. DISCUSSIONS: Thermographic findings of an extended area of increased skin temperature not limited to the callus may suggest the progression of a callus to ulcer. Expansion of the area of increased skin temperature might show the inflammation or infection extending along the fascia. Based on these findings, thermography could provide a useful assessment of callus in DM patients with a high risk of progression.

Factors Associated With Callus in Patients with Diabetes, Focused on Plantar Shear Stress During Gait.

BACKGROUND: The aim of this study is to identify whether plantar shear stress in neuropathic patients with diabetes with callus is increased compared with those without callus. METHOD: The differences in foot deformity, limited joint mobility, repetitive stress of walking, and ill-fitting shoes between patients with callus and those without callus were also determined. Subjects were recruited from the Diabetic Foot Outpatient Clinic. A newly developed in-shoe measurement system, which has flexible and thin insoles, enabled measurement of both plantar pressure and shear stress simultaneously when subjects walked as usual on a 10 m walkway. RESULTS: It was found that plantar shear stress adjusted for weight during the push-off phase was increased by 1.32 times in patients with callus compared with those without callus (mean ± SD: 0.0500 ± 0.0160 vs 0.0380 ± 0.0144, P = .031). Moreover, hallux valgus deformity, reduction in dorsiflexion of the ankle joint and increase in plantar flexion were showed in feet with callus. Increased plantar shear stress may be caused by gait change that patients having callus push off with the metatarsal head instead of the toe as a result of foot deformity and limited joint mobility. CONCLUSIONS: It was found that plantar shear stress adjusted for weight during the push-off phase was increased in patients with callus compared with those without callus by using the newly developed measurement system. These results suggest that reduction of plantar shear stress during the push-off phase can prevent callus formation in neuropathic patients with diabetes.

Shear Stress-Normal Stress (Pressure) Ratio Decides Forming Callus in Patients with Diabetic Neuropathy.

Aim. Callus is a risk factor, leading to severe diabetic foot ulcer; thus, prevention of callus formation is important. However, normal stress (pressure) and shear stress associated with callus have not been clarified. Additionally, as new valuables, a shear stress-normal stress (pressure) ratio (SPR) was examined. The purpose was to clarify the external force associated with callus formation in patients with diabetic neuropathy. Methods. The external force of the 1st, 2nd, and 5th metatarsal head (MTH) as callus predilection regions was measured. The SPR was calculated by dividing shear stress by normal stress (pressure), concretely, peak values (SPR-p) and time integral values (SPR-i). The optimal cut-off point was determined. Results. Callus formation region of the 1st and 2nd MTH had high SPR-i rather than noncallus formation region. The cut-off value of the 1st MTH was 0.60 and the 2nd MTH was 0.50. For the 5th MTH, variables pertaining to the external forces could not be determined to be indicators of callus formation because of low accuracy. Conclusions. The callus formation cut-off values of the 1st and 2nd MTH were clarified. In the future, it will be necessary to confirm the effect of using appropriate footwear and gait training on lowering SPR-i.

Establishment of a measurement method for in-shoe pressure and shear stress in specific regions for diabetic ulcer prevention.

Pressure and shear stress are the factors of diabetic foot ulcers and callus formation. However, in-shoe shear stress of callus measurement could not have been measured because of technical difficulties. The purpose of this study is to verify reliability and validity of the established measurement system for in-shoe pressure and shear stress. For reliability, coefficients of variation (CV) and intraclass correlation coefficients (ICC) were confirmed. For known-groups validity, callus and non-callus feet were compared. Mean CV was 9.7%. Mean ICC was 0.943. For validity test, mean peak pressure and shear stress of the six callus feet was significantly higher than that of the eighteen non-callus feet. The pressure and shear stress that causes callus and diabetic foot ulcer will be identified in diabetic neuropathy patients.

Association between Washing Residue on the Feet and Tinea Pedis in Diabetic Patients.

Tinea pedis (TP) may lead to the development of foot ulcers in diabetic patients; thus, its prevention in diabetic patients is important. TP occurs after dermatophytes on the skin scales of TP patients attach to the feet. Therefore, it is necessary to remove the scales and dermatophytes, and this can be performed using various methods, including foot washing. This study aimed to objectively examine the association between the presence of TP and foot-washing habits. We included 33 diabetic patients, and, of these, 17 had TP. The presence of washing residue on the feet was determined by applying a fluorescent cream to the participants' feet, and images of the feet were captured under ultraviolet light before and after foot washing. Our results showed that diabetic patients with TP had higher levels of washing residue on their feet than those without TP. The importance of washing feet to prevent TP needs to be emphasized through educational programs for diabetic patients. Furthermore, the development of an effective foot-washing technique is essential.