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The Podiatrist Can Provide Screening For Peripheral Vascular Disease With A ...



The podiatrist can provide screening for peripheral vascular disease with a Doppler examination and also determine the ankle / brachial index as an indication of arterial or venous impairment. Such measures are of critical importance as current figures suggest that there is a risk of a non-fatal cardiac event within five years of 20% if peripheral vascular disease is detected and a 30% mortality risk within the same time span if treatment is not instituted promptly. (ADA 2003)

The microvascular complications are of less direct relevance to the podiatrist as the incidence of these is directly related to the long term control of the hyperglycaemia (as reflected in the HbA1 levels). Encouraging strict compliance with the therapeutic regime is of prime importance here. (Sage R A et al. 2001)
Arthritis.
The commonest form of arthritis seen in podiatry practice in the older patient is osteoarthritis. This is a condition of unknown aetiology but it is believed to have a strong genetic component. In simple terms it is manifest by increased wear on the articular surfaces until the articular cartilage is worn away when restriction of movement gives way to pain on movement as the predominant symptom. (Saltzman C et al. 2004).

Rheumatoid arthritis is less common and with a completely different pathophysiology. It is primarily an inflammatory arthritis of the autoimmune variety. It is generally relentlessly progressive with sporadic and chronic inflammation of the synovial membranes of the joints which results in characteristic patterns of erosion of the articular surfaces and damage to the perisynovial structures. (Van Roermund P M et al. 1998)

Peripheral vascular disease.
This is usually an age related phenomenon and therefore most frequently seen in the older age groups. It can be idiopathic (related to hypertensive disease) or secondary to conditions such as diabetes mellitus (above) or other conditions such as hyperlipidaemia or smoking. The screening and holistic elements of treatment have been addressed under the diabetes mellitus heading.


Tie in the need for clinical effectiveness in regards to best practice and the concept of accountability and interprofessional working.
Evidence based healthcare.
Evidence based healthcare has been progressively in the ascendancy arguably over the last two decades. This can clearly be seen with a brief overview of the published literature in the peer reviewed press. The majority of papers written in the late 70s and 80s were essentially overviews and personal opinions (Evidence levels III and IV) . Thereafter it became far more commonplace to see professional articles written on carefully constructed randomised controlled trials (Evidence level I).


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