Achilles Project: An Epidemiology Survey to Assess the Seasonal Incidence of Foot Diseases and Patient Compliance

Ro, Byung In; Yang, Kyung Mee

Abstract

BACKGROUND: Dermatological diseases affecting the feet, e.g. fungal infections and nail infections, are often not fully perceived as real medical problems even when they experience great discomfort, including pain. These misperception often prevents from seeking timely treatment, which can result in very severe conditions. This survey, so called "ACILLES PROJECT" was a "foot screening" project that would be focused on all parts of the body below the Achilles heel: foot, toe and toenails.
OBJECTIVE
This study was undertaken for both medical doctors and patients to raise the awareness of foot diseases and additional insights into disease that could affect foot. And also, in seasonal variation, we tried to compare the epidemiological data and to look over the relationship of dermatophytosis in other parts with fungal infections in foot and to analyze the compliance and efficacy of antifungal agents in the treatment of patients who were diagnosed as dermatophytosis in their feet in the treatment of antifungal agents.
METHODS
Achilles survey was conducted for one week from 7th July to 13th July, 1997 and 16th March to 17th April, 1998 co-worked by the Korean Society for Medical Mycology and Janssen Korea. In 1997, 19,298 patients, who visited dermatology and urology, and 353 investigators participated in this survey. And Achilles 98, in 1998, was composed of two parts, Unit I and Unit II. Unit I survey was a foot disease consult program and Unit II was a patient compliance survey 29,922 patients, 391 investigators and 16,383 patients, 350 investigators were involved in Unit I and Unit II respectively.
RESULTS
Among total 29,922 patients who responded to the survey, 57.7% of them had more than one foot disease. There was no big difference comparing with the number (67%) in the survey of last summer. And it was observed that fungal infection was the most dominant disease (79.8%) regardless of seasons (83.7% in July, 1997). Furthermore, there were no significant differences in the prevalence of other foot diseases for each season (eczema 11.1%, corns 5.1%, warts 2.7%, psoriasis 2.1%). Oral antifungal agents were prescribed to the patients who were diagnosed as having fungal infections in their feet in order to survey drug compliance by filling out the patients diary. In compliance, only 24% of patients in itraconazole pulse therapy for 28 days and 16% of patients in itraconazole continuous therapy for 28 days compiled with their dosage guideline exactly. It is observed that the longer the duration of drug therapy is, the worse the patients compliance is.
CONCLUSION
According to the epidemiological survey in 1997 and 1998, the prevalence of foot disease was not significantly different seasonally, and it was reported that the awareness of and the intention for the treatment of foot diseases were not high enough based on the compliance data of patients.