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Autonomic neuropathy in the diabetic foot is associated with decreased sweating, loss of skin temperature regulation and interruption of sympathetic nerve function. The associated sudomotor dysfunction can cause anhidrosis in the feet, leading to callus, fissures or ulceration. There is no internationally recommended or recognised standardised tool to diagnose sudomotor dysfunction in the lower limb, and it is also unclear if currently available tools validly measure anhidrosis. This study investigates associations between clinician-observed anhidrosis, Neuropad®-detected anhidrosis and Michigan Neuropathy Screening Instrument (MNSI) findings in a sample of 50 participants with diabetes who attended a community podiatry service in the West of Ireland. Diabetic peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument and Neuropad. The clinician-observed anhidrosis did not correlate with MNSI or Neuropad findings. [ABSTRACT FROM AUTHOR]

Objective: To estimate the cost of wound care to the Irish health-care system. Methods: A bottom-up, prevalence-based analysis was undertaken using a decision analytic model to estimate costs. Health-care resource activity was identified from a recently published study from the UK and was valued using unit cost data for Ireland. Results: The base case analysis estimated the total annual healthcare cost of wound care to be €629,064,198 (95% Confidence interval (CI): €452,673,358 to €844,087,124), accounting for 5% (95% CI: 3% to 6%) of total public health expenditure in Ireland in 2013. The average cost per patient was €3,941 (95% CI: €2,836 to €5,287). However, this study is subject to many limitations and plausible changes in the model's inputs showed that the total annual health-care cost of wound care could range from €281,438,970 to €844,316,912. Conclusion: Caring for wounds places a substantial burden on the Irish health-care system. In light of growing pressures to finance an already resource-constrained health-care system, these results provide useful information for those charged with future wound care service design and provision in Ireland and elsewhere. [ABSTRACT FROM AUTHOR]

Aim: To investigate wellbeing in those who are at high risk of or living with an active diabetic foot ulcer (DFU) attending a community Podiatry clinic in the West of Ireland. Method: A total of 25 participants at risk or/ active DFUs were recruited. In addition to demographic information, Phase 1 (n = 25) assessed: Spirituality Self Rating Scale (SSRS), Hearth Hope Index (HHI), Hospital Anxiety and Depression Score (HADS), Rosenberg Self-Esteem Scale (RSES) and Powerlessness Assessment Tool (PAT). Phase 2 (n = 10) utilised a qualitative approach and explored the lived experience of those at high risk (n=4) and those living with active (n = 6) DFU through one-to-one follow-up interviews. Results / Discussion: Sixty-four percent (n=16) had current ulceration. Mean age was 69.64 (±11.47) and disease duration 21.28 years (±10.76). Male: Female gender distribution was 76% (n = 19)/ 24% (n = 6). The following mean scores were identified: SSRS 21.24 (±6.78), HHI 37.28 (±6.17), RSES 20.84 (±5.02), PAT 28.88 (±7.91), and HADS = 9 (±5.33). Individuals with current DFU presented with lower levels of self-esteem, stronger feelings of powerlessness, higher levels of depression and lower levels of anxiety when compared to those who were at risk, but not currently ulcerated. Conclusion: Participants living with current DFUs reported stronger feelings of powerlessness, lower self-esteem and higher depression scores than those who are high risk of DFUs. Those with current DFUs reported significantly lower anxiety levels compared to the high-risk group. Healthcare professionals should consider the impact that DFU may have on wellbeing and future work should investigate if addressing these factors can improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Falls and fall-related injuries are a serious cause of morbidity and cost to society. Foot problems and inappropriate footwear may increase the risk of falls; therefore podiatric interventions may play a role in reducing falls. Two Cochrane systematic reviews identified only one study of a podiatry intervention aimed to reduce falls, which was undertaken in Australia. The REFORM trial aims to evaluate the clinical and cost-effectiveness of a multifaceted podiatry intervention in reducing falls in people aged 65 years and over in a UK and Irish setting., Methods and Analysis: This multicentre, cohort randomised controlled trial will recruit 2600 participants from routine podiatry clinics in the UK and Ireland to the REFORM cohort. In order to detect a 10% point reduction in falls from 50% to 40%, with 80% power 890 participants will be randomised to receive routine podiatry care and a falls prevention leaflet or routine podiatry care, a falls prevention leaflet and a multifaceted podiatry intervention. The primary outcome is rate of falls (falls/person/time) over 12 months assessed by patient self-report falls diary. Secondary self-report outcome measures include: the proportion of single and multiple fallers and time to first fall over a 12-month period; Short Falls Efficacy Scale-International; fear of falling in the past 4 weeks; Frenchay Activities Index; fracture rate; Geriatric Depression Scale; EuroQoL-five dimensional scale 3-L; health service utilisation at 6 and 12 months. A qualitative study will examine the acceptability of the package of care to participants and podiatrists., Ethics and Dissemination: The trial has received a favourable opinion from the East of England-Cambridge East Research Ethics Committee and Galway Research Ethics Committee. The trial results will be published in peer-reviewed journals and at conference presentations., Trial Registration Number: Current Controlled Trials ISRCTN68240461 assigned 01/07/2011., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)