Modification of midfoot bone stress with functional foot orthoses

Halstead-Rastrick, Jill (2013) Modification of midfoot bone stress with functional foot orthoses. PhD thesis, University of Leeds.

Abstract

Studies of foot orthoses suggest that they can improve foot pain and function, although the precise mode of action of foot orthoses is poorly understood. It is proposed that they may act through the modification of abnormal stresses or motions occurring within the foot. The central aim of this thesis is to explore whether functional foot orthoses can systematically modify bone stress in the midfoot as measured on magnetic resonance imaging. Bone marrow lesion patterns quantified on magnetic resonance imaging was proposed as a surrogate measure of bone stress in the foot. A reliable method of bone segmentation and BML volume measurement was developed and applied in this thesis. In the interventional study of this thesis, the effect of functional foot orthoses on mechanical medial midfoot pain, foot impairment, patterns of bone marrow lesions and foot kinematics were investigated. Thirty seven participants with mechanical midfoot pain and medial midfoot bone marrow lesions participated in the study and were allocated to wear either functional foot orthoses (n=21) or a cushioning insole (n=16). The effect of the orthosis intervention on foot pain, impairment and volumes of magnetic resonance bone marrow lesions was compared in each group. In addition, the gait parameters and foot kinematics were assessed in a subset of 20 participants (functional foot orthoses n=10 and cushioning insole n=10). Foot pain and foot impairment outcomes improved more in the functional foot orthoses group than the control group wearing cushioning insoles. The results suggest that the volumes of bone marrow lesions in the medial foot bones were reduced systematically in the functional foot orthoses group. In comparison, those wearing the cushioning insole showed no change greater than measurement error. There was no evidence in the small subset of 7 participants, that foot kinematics were systematically altered when wearing either the cushioning insole or functional foot orthoses compared to in-shoe only analyses. The results reported in this thesis suggest that the biomechanical mechanism of functional foot orthoses in treating foot pain could be the modification of internal forces rather than their systematically influencing magnitudes of foot motion. This new data indicates that functional foot orthoses appear to have the potential to reduce foot pain and alter patterns of bone marrow lesions (a surrogate measure of bone stress) in the medial midfoot bones and further work is now required to explore this formally in larger studies.

Source: http://etheses.whiterose.ac.uk/4849/

BAPO Insurance Additional Information

Please click here for additional information on BAPO insurance 2014

BAPO Conference & Exhibition 2014 - Delegate Registrations Now Open!

BAPO are pleased to announce the opening of delegate registrations for Conference & Exhibition 2014 please take advantage of the Early Bird discount which closes on 31 December 2013 BAPO members wishing to register should use their current login details to access BAPOnline - www.bapo.com Non-members should click on the link below, provide details requested, enter the Non Members activation in the box provided, in order to register and access BAPOnline - www.bapo.com http://www.bapo.com/Application/Member/SelfRegistration.aspx For further information or enquiries please contact the Secretariat on 0141 561 7217 or email conference@bapo.com

BAPO Conference & Exhibition 2014 - Call for Papers Reminder

BAPO are seeking presentations both Prosthetic and Orthotic of 12 minutes duration with up to 3 minutes for questions and answers.

 

For more details download submission instructions here

2014 Limbcare Technician of the Year Award

The BAPO Technician Committee are pleased to announce the launch of the Limbcare Technician of the Year Award.  For details on how to nominate please click here and for nomination forms download here

Effect of an ankle–foot orthosis on knee joint mechanics: A novel conservative treatment for knee osteoarthritis

Cynthia H Fantini Pagani; Steffen Willwacher; Rita Benker; Gert-Peter Brüggemann

Abstract

Background: Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success.

Objective: To analyze the effect of an ankle–foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment.

Study design: Controlled laboratory study, repeated measurements.

Methods: In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle–foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis.

Results: Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle–foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles.

Conclusion: The ankle–foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane.

Clinical relevance This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis.

Source: http://poi.sagepub.com/content/early/2013/12/10/0309364613513297.abstract

Speakeasy - BAPO Conference 14th-16th March 2014

Speakeasy Flyer (exclusively for recent graduates (2011-2013) and students) BAPO Conference 14th-16th March 2014

HCPC News Release 4/12/13

News release

Wednesday 4 December 2013

Outcomes of the consultation on the Health and Care Professions Council (HCPC) registration fees

At its most recent meeting, the HCPC Council agreed to proposals to increase the registration renewal fee to £80 per year.  The Council also agreed a similar level of increases to other registration fees.

The Council's decision to increase the fees was carefully considered and followed an in-depth analysis of the responses to the fees consultation which closed recently.

Marc Seale, Chief Executive and Registrar commented;

"We are very aware of the concerns raised by registrants about these increases and of the economic context in which we operate.  For this reason, we have consciously managed our costs as efficiently as we can whilst striving to improve our effectiveness.

"The fees we charge pay for all our operating costs.  However, these fees have not increased since 2009 despite rising costs. We have worked hard to limit the increases as much as possible, but it is crucial that we have sufficient funds to continue to operate efficiently and effectively in protecting the public.

"The new fee structure still means we have the lowest renewal fee of all the regulators overseen by the Professional Standards Authority.  It also allows us to manage increases in costs in an incremental way, preventing financial difficulties which might otherwise lead to substantial unplanned increases to the fees."

Subject to parliamentary approval, the new registration fee structure will come into effect on 1 April 2014.

A full summary of the responses to the consultation is available on our website at www.hcpc-uk.org/aboutus/consultations/closed/index.asp?id=160<file:///C:\Users\gaylee\AppData\Local\Temp\>. The report contains an analysis of the responses we received as well as our comments and decisions. We also have answers to a series of 'frequently asked questions' about the revised registration fees at www.hcpc-uk.org/registrants/fees/consultation<file:///C:\Users\gaylee\AppData\Local\Temp\>

BAPO Conference & Exhibition 2014 - OETT Technician Training Day

OETT sponsorship of this event has allowed us to once again offer the first 15 full paying Technicians to register the opportunity to bring along a colleague FREE OF CHARGE *!

 

Simply complete and return the attached registration forms or download from http://www.bapo.com/

 

*Offer applies to registrations received from full paying P&O Technicians only

*Only P&O Technicians can benefit from free registration offer

*Free registration applies to Friday 14 March only

*Access to Training Day and Trade Exhibition from 5pm

 

OETT Technician Training Day 2014 Flyer

 

Delegate Registration Form 2014

 

Technician Free Place Registration Form 2014

 

Studies examine ways to optimize OA bracing

Research continues to suggest that bracing has the ability to improve pain and function in patients with knee osteoarthritis.  This article offers some recent reviews of literature and tips on compliance.

http://lowerextremityreview.com/article/studies-examine-ways-to-optimize-oa-bracing

BAPO Conference & Exhibition 2014 - Call for Posters

In addition to the clinical programme BAPO will be running a poster competition, submissions will be divided into four groups: Prosthetists/Orthotists; Technicians/Assistants; Students and other.  The best poster in each group will be awarded £100 with a bottle of bubbly awarded to the runners up in each category. 

 

For full details please click here

HCPC News Release

Wednesday 20 November 2013

New research commissioned by the HCPC shows that one in five 'doubted fitness to practise' of a health or care professional

The Health and Care Professions Council (HCPC) is launching new research today which finds that a fifth of UK adults have encountered behaviour from a health or care professional that made them doubt their fitness to practise.

More than a quarter said the health or care professional in question seriously or persistently failed to meet standards whilst 16 per cent said they felt the professional failed to respect the rights of a patient to make their own choices.  Thirteen per cent felt they were 'hiding mistakes' and a further nine per cent felt they were exploiting vulnerable patients.  One in twenty said they had experienced or witnessed reckless or deliberately harmful acts.

Despite these figures, just three out of ten reported their concerns, with a further 73 per cent of adults who would not know where to go to report concerning behaviour.

The data, released today supports research commissioned by the HCPC earlier in the year into what the general public feel they need protection from most.  Findings from this report show that Illegal drug taking and shoplifting were far more likely to concern members of the public than convictions for drink driving. Dishonesty and fraud were also key concerns for most.

Brian James, Head of Assurance and Development said:

"The vast majority of HCPC registrants practise safely and effectively and within nationally agreed standards for professional skills and behaviour. However, on the rare occasion that a registrant does not meet HCPC standards, action can be taken including imposing sanctions or stopping them from practising in the most serious of cases. After looking at the key findings in this research it is reassuring to know that we are dealing with the issues that the public feel they need protecting from the most."

The HCPC's 2013 annual fitness to practise report<http://www.hcpc-uk.org/publications/reports/index.asp?id=709>, which has just been published, shows the action the HCPC is taking to protect the public.

Anyone can contact the HCPC to raise a concern about a registrant. This includes members of the public, employers, the police and other professionals.

Save the Date

Save the Date for the BAPO conference 2014.

 

When: 14^th-16^th March
Where: The Point, Lancashire County Cricket Club, Old Trafford, Manchester.

Its set to be a Fantastic Weekend with some great speakers so don't miss out Save the Date now!

BAPO Conference & Exhibition 2014 Call for Papers

BAPO are seeking presentations both Prosthetic and Orthotic of 12 minutes duration with up to 3 minutes for questions and answers.

 

For more details download submission instructions here

Physiotherapy to Complement Orthotic Treatment

Physiotherapy to Complement Orthotic Treatment

Saturday 12th October 2013

**last chance to book on this course**

This course aims to:

Share how physiotherapists look at patients regarding an assessment and detail what elements of that assessment may lead to the involvement of orthotics.

 

Explore reasoning behind physiotherapy intervention, namely core stability, flexibility, strength, pathology, neurological involvement etc.

 

The event will be delivered by tutors who are also active clinicians using audio/visual aids as appropriate. We may call upon willing delegates to participate in the direct delivery of the syllabus. There will group discussions and case studies.

 

Contact hours: 6 hours plus 2 hours of independent reading

 

 

Physiotherapy to Complement Orthotic Treatment Short Course

LimbPower Holding Primary & Junior Games at Stoke Mandeville Stadium

Following the huge success of last year's inaugural Junior Games, LimbPower are proud to be holding this fantastic event once again at Stoke Mandeville Stadium, birthplace of the Paralympics. The weekend will introduce young amputees and the young ambulant disabled to a range of sporting activities in a safe, friendly and inclusive environment.

Saturday 5th October will see those aged 5-11 able to try out a variety of sports including athletics, cycling, football, tennis and basketball in 'Have a Go' sessions under the guidance of experienced mentors and instructors from each sport's governing body. The emphasis is on fun while encouraging the children to have a go at sports and socialise with their peers.

On Sunday 6th October the older children aged between 11-18 will be able to have a go at key Paralympic sports, with instruction from qualified coaches and experienced athletes. They will be able to try out a wide range of sports including; athletics, Powerlifting, basketball, sitting volleyball, archery, football, cycling, swimming and tennis. They will be able to have fun and also perhaps find some hidden talents. We may even discover the Paralympians of the future!

"We're thrilled to be able to run this event again and offer the same opportunities to children that we have been offering to adults at the Amputee Games" said Kiera Roche, LimbPower Chairman. "Last year was such a great success, and we're hoping to reach even more young people and give them the chance to challenge what they think they are capable of."

Juliette Woolf, mother of Rio Woolf who took part last year, commented; "The 2012 LimbPower Primary Games were life-changing for Rio - he absolutely loved trying all the different para-sports on offer and making friendships with other "children with special arms and legs" which will last a lifetime - they had an instant bond!"

The Primary & Junior Games will help young amputees to learn new skills, have fun and importantly to discover their potential through sport. Anyone interested in taking part should contact Kiera Roche from LimbPower on: 07502 276858 or kiera@limbpower.com Alternatively registration forms can be downloaded from the website at www.limbpower.com/junior-games/

Surgical versus non‐surgical interventions in patients with adolescent idiopathic scoliosis

Surgical versus non‐surgical interventions in patients with adolescent idiopathic scoliosis

J Bettany‐Saltikov, HR Weiss, N Chockalingam… - The Cochrane Library, 2013

... Whilst scoliosis-specific exercises use internal corrective forces (ie muscles), braces use external
corrective forces ... However, some braces (called soft braces) are made of material similar to elas-
tic bands ... of the brace are used to straighten the spine and derotate the pelvis and ...

Retrospective Cohort Study ofthe Economic Value of Orthotic and Prosthetic Services

Medicare recipients given orthotic and prosthetic devices were more likely to remain active in the community and avoid facility-based care than similar Medicare patients who didn't receive such devices, a retrospective study found.

For example, patients receiving lower-extremity orthoses had fewer hospitalizations and emergency department (ED) admissions, and had about 10% lower Medicare costs after 18 months (P<0.05). Comparable Medicare savings were seen in patients with spinal orthoses and they also relied less on facility-based care (P<0.05).

The study results will be used to urge Medicare and other payers to make it easier for patients in need of prosthetics to receive them, the Amputee Coalition, a Manassas, Va.-based advocacy group that commissioned the study, said Tuesday.

The advocates said patients who receive orthoses and prosthetics will save Medicare money in the long run.

Although they relied less on facility-based care, patients receiving the orthotic and prosthetic devices did have more falls and fractures, and average Medicare episode payments weren't always lower. The increase in falls was most likely due to increased mobility because of the device, according to Allen Dobson, president of Dobson DaVanzo & Associates in Vienna, Va., the consulting firm that conducted the study.

"The increased physical therapy among O&P [orthoses and prosthetic] users allowed patients to become less bed-bound and more independent, which may be associated with higher rates of falls and fractures, but fewer emergency room admissions and acute care hospital admissions," the report concluded. "This reduction in health care utilization ultimately makes O&P services cost-effective for the Medicare program and increases the quality of life and independence of the patient."

Dobson, a former research director at the Centers for Medicare and Medicaid Services (CMS), and colleagues examined CMS data from 2007 to 2010 for patients who either had an amputation within the last year or who met predetermined etiological diagnoses. Patients who received a lower-extremity or spinal orthotic or prosthetic device were compared with those who hadn't received such devices.

The study compared healthcare utilization, Medicare payments, and negative outcomes such as fall and emergency department admissions for up to 18 months after receiving the device.

Generally, patients were found to be more mobile and therefore able to receive the physical therapy and rehabilitation required, and to avoid facility-based care.

With the data in hand, advocates hope it will be easier for patients to receive authorization for the devices.

"Insurers want to see the data that the healthcare system is better off if the service is provided," Susan Stout, interim president and chief executive of the Amputee Coalition, said in a call with reporters. "Now that the study is completed, we intend to use the information contained in the study to achieve fair insurance coverage for prosthetic devices."

Providers must prove the medical necessity of devices before insurers will pay for their use, a step which can be burdensome to patients and physicians. Insurers also have a tendency to provide the least expensive prostheses rather than one that maximizes a patient's mobility.

"For the first time, we can actually use the data ... that clearly demonstrates the efficiency and the efficacy of the services that we provide," Thomas Kirk, PhD, president of theAmerican Orthotic & Prosthetic Association, said in a call with reporters. "Not only are we providing services that can help out patients, we are also helping the American taxpayers save money."

While payers don't deny the devices, a number of patients are underserved by insurers, the advocates said on the call Tuesday. "Many payers have seen the cost of a prosthesis in a vacuum rather than seeing it as actually contributing to the overall improved health of the patient," Kirk said.

The authors hope to publish the results in a medical journal later.

Source: http://www.medpagetoday.com/PublicHealthPolicy/Medicare/41260

Link to report: http://www.amputee-coalition.org/content/documents/dobson-davanzo-report.pdf

Effect of rocker shoes on pain, disability and activity limitation in patients with rheumatoid arthritis

Masumeh Bagherzadeh Cham, Mohammad Sadegh Ghasemi, Bijan Forough, Mohammad Ali Sanjari, Mozdeh Zabihi Yeganeh, Arezoo Eshraghi

Abstract

Background: Rheumatoid arthritis is a chronic inflammatory joint disease which affects the joints and soft tissues of the foot and ankle. Rocker shoes may be prescribed for the symptomatic foot in rheumatoid arthritis; however, there is a limited evidence base to support the use of rocker shoes in these patients.

Objectives: The aim of this study was to evaluate the effectiveness of heel-to-toe rocker shoes on pain, disability, and activity limitation in patients with rheumatoid arthritis.

Study design: Clinical trial.

Methods: Seventeen female patients with rheumatoid arthritis of 1 year or more duration, disease activity score of less than 2.6, and foot and ankle pain were recruited. Heel-to-toe rocker shoe was made according to each patient's foot size. All the patients were evaluated immediately, 7 and 30 days after their first visit. Foot Function Index values were recorded at each appointment.

Results: With the use of rocker shoes, Foot Function Index values decreased in all subscales. This reduction was noted in the first visit and was maintained throughout the trials.

Conclusion: Rocker shoe can improve pain, disability, and activity limitation in patients with rheumatoid foot pain. All the subjects reported improved comfort levels.

Clinical relevance The results of this study showed that high-top, heel-to-toe rocker shoe with wide toe box was effective at reducing foot and ankle pain. It was also regarded as comfortable and acceptable footwear by the patients with rheumatoid foot problems.

Suspended without pay

HCPC REGISTRATION RENEWAL REMINDER
DEADLINE:  30 SEPTEMBER 2013

Can you afford to be suspended without pay?  46% of P&O registrants still have not re-registered with HCPC.  All registrants must re-register by 30th September 2013 or you will be unable to practice as a Prosthetist or Orthotist.  Re-registration only takes 5 minutes and can be done simply online on the HCPC website.
 
http://www.hpc-uk.org/aboutregistration/theregister/

Paediatric Gait Analysis and Orthotic Management - BAPO Run Short Course - 8th & 9th November 2013

This Course Aims to: 

Explore a fresh approach to the observation and analysis of normal gait and standing, and the classification and management of gait disorders. The biomechanics of normal gait and standing, and the pathological gaits of disabling conditions will be extensively reviewed, with particular reference to orthotic management. Pre-gait analysis and orthotic management assessment will be demonstrated. The emphasis of patient cases will focus on cerebral palsy, myelomeningocoele and other neurological conditions. Participants will gain a knowledge of the aims of orthotic management and how to achieve them through: the biomechanics of ankle-foot orthoses, the influence of footwear, varieties of ‘AFO Footwear Combination’ design, tuning ‘AFO Footwear Combinations’ to optimise gait and extensive video examples. In addition live patient demonstrations will help participants refine their clinical decision making skills involved in gait analysis and orthotic design.

                                                          Paediatric Gait Analysis and Orthotic Management

Register as a stakeholder for a Clinical Reference Group

Registration is now open for anyone with an interest in the work of the Specialised Services Clinical Reference Groups (CRGs).  To become a stakeholder in a particular CRG you will most likely be a patient, carer, a member of the public, a member of a voluntary organisation, or a clinical or non-clinical professional.

Physiotherapy to Complement Orthotic Treatment

This course aims to:

Share how physiotherapists look at patients regarding an assessment and detail what elements of that assessment may lead to the involvement of orthotics.

Explore reasoning behind physiotherapy intervention, namely core stability, flexibility, strength, pathology, neurological involvement etc.

The event will be delivered by tutors who are also active clinicians using audio/visual aids as appropriate. We may call upon willing delegates to participate in the direct delivery of the syllabus. There will group discussions and case studies.

Contact hours: 6 hours plus 2 hours of independent reading

Physiotherapy to Complement Orthotic Treatment Short Course

Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the Oxford Foot Model

Matthias Höslemail, Harald Böhm, Christel Multerer, Leonhard Döderlein

Treatment of asymptomatic flexible flatfeet is a subject of great controversy. The purpose of this study was to examine foot function during walking in symptomatic (SFF) and asymptomatic (ASFF) flexible flatfeet. Thirty-five paediatric and juvenile patients with idiopathic flexible flatfeet were recruited from an orthopaedic outpatient department (14 SFF and 21 ASFF). Eleven age-matched participants with typically developing feet served as controls (TDF). To study foot function, 3D multi-segment foot kinematics and ankle joint kinetics were captured during barefoot gait analysis. Overall, alterations in foot kinematics in flatfeet were pronounced but differences between SFF and ASFF were not observed. Largest discriminatory effects between flatfeet and TDF were noticed in reduced hindfoot dorsiflexion as well as in increased forefoot supination and abduction. Upon clinical examination, restrictions in passive dorsiflexion in ASFF and SFF were significant. During gait, the hindfoot in flatfeet (both ASFF and SFF) was more everted, but less flexible. In sagittal plane, limited hindfoot dorsiflexion of ASFF and SFF was compensated for by increased forefoot mobility and a hypermobile hallux. Concerning ankle kinetics, SFF lacked positive joint energy for propulsion while ASFF needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles in ASFF. Hence, despite a lack of symptoms flatfoot deformity in ASFF affected function. Yet, contrary to what was expected, SFF did not show greater deviations in 3D foot kinematics than ASFF. Symptoms may rather depend on tissue wear and subjective pain thresholds.

http://www.gaitposture.com/article/S0966-6362(13)00251-8/abstract

--

Jonathan 

Prosthetic finger out of Bicle Parts

Colin MacDuff invents prosthetic finger out of BICYCLE partsDaily Mail

Mr Macduff constructed the prosthetic device using leftover bike parts, ... but doctors told him that there were no prosthetics for finger amputees available.

NICE Stroke Rehabilitation Guideline

Stroke rehabilitation: long-term rehabilitation after stroke

Clinical guidelines, CG162 - Issued: June 2013

This guideline offers evidence-based advice on the care of adults and young people aged 16 years and older who have had a stroke with continuing impairment, activity limitation or participation restriction.

http://www.nice.org.uk/nicemedia/live/14182/64098/64098.pdf

NICE has published good practice guidance on patient group directions (PGDs)

The guidance has been developed to help individuals and organisations who are considering the need for, developing, authorising, using and/or updating PGDs to ensure they are appropriate, legal and that relevant governance arrangements are in place within commissioning and provider organisations.

The guidance underlines that supplying and/or administering medicines under PGD should be reserved for situations where this offers an advantage for patient care without compromising patient safety and where there are clear governance arrangements and accountability.

Physiotherapy to Complement Orthotic Treatment Saturday 12th October 2013

For further information on the 'Physiotherapy to Complement Orthotic Treatment' BAPO Short Course please follow the link below:

Further Information

Please note that the cancellation date of this course is 2 September 2013.  If you wish to book a place on the BAPO short course then please do so at your earliest convenience.

The clinical management of diabetic foot in the elderly and medico-legal implications

Claudio Terranova, Andrea Bruttocao

Abstract

Diabetic foot is a complex and challenging pathological state, characterized by high complexity of management, morbidity and mortality. The elderly present peculiar problems which interfere on one hand with the patient's compliance and on the other with their diagnostic-therapeutic management. Difficult clinical management may result in medico-legal problems, with criminal and civil consequences. In this context, the authors present a review of the literature, analysing aspects concerning the diagnosis and treatment of diabetic foot in the elderly which may turn out to be a source of professional responsibility. Analysis of these aspects provides an opportunity to discuss elements important not only for clinicians and medical workers but also experts (judges, lawyers, medico-legal experts) who must evaluate hypotheses of professional responsibility concerning diabetic foot in the elderly.

http://msl.sagepub.com/content/early/2013/08/06/0025802412473595.abstract

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

TL Lin, HM Sheen, CT Chung, SW Yang, SY Lin… - … of Foot and Ankle Research, 2013

... However, what the four insole conditions will be, the configurations, and possible biomechanical
effects, were not told. ... 18. Menz HB: Two feet, or one person? Problems associated with statistical
analysis of paired data in foot and ankle medicine. Foot 2004, 14(1):2–5. 19. ...

How Effective Is Orthotic Treatment in Patients with Recurrent Diabetic Foot Ulcers?

Maria Luz Gonzalez Fernandez, PhD, Rosario Morales Lozano, PhD, Maria Ignacia Gonzalez-Quijano Diaz, PhD, Maximo Antonio Gonzalez Jurado, PhD, David Martinez Hernandez, MD and Juan Vicente Beneit Montesinos, MD

Abstract

Background: We assessed the efficacy of customized foot orthotic therapy by comparing reulceration rates, minor amputation rates, and work and daily living activities before and after therapy. Peak plantar pressures and peak plantar impulses were compared with the patients not wearing and wearing their prescribed footwear.

Methods: One hundred seventeen patients with diabetes were prescribed therapeutic insoles and footwear based on the results of a detailed biomechanical study and were followed for 2 years. All of the patients had a history of foot ulcers, but none had undergone previous orthotic therapy.

Results: Before treatment, the reulceration rate was 79% and the amputation rate was 54%. Two years after the start of orthotic therapy, the reulceration rate was 15% and the amputation rate was 6%. Orthotic therapy reduced peak plantar pressures in patients with reulcerations and in those without (P < .05), although a significant decrease in peak plantar impulses was achieved only in patients not experiencing reulceration. Sick leave was reduced from 100% to 26%.

Conclusions: Personalized orthotic therapy targeted at reducing plantar pressures by off-loading protects high-risk patients against reulceration. Treatment reduced the reulceration rate and peak plantar pressures, leading to patients' return to work or other activities. (J Am Podiatr Med Assoc 103(4): 281-290, 2013)

Source: http://www.japmaonline.org/content/103/4/281.short

THE MANIC MARAFUN!

The Manic Marafun is a 26 mile challenge, but with a difference.  Each participant only has to do one mile, or four laps of the track at the wonderful Stoke Mandeville Stadium, and to make it even more appealing, they can choose from a variety of wacky ways in which to complete it.  Whether it be running, walking backwards, cycling, scooting, pushing a day chair or even doing the wheelbarrow with a friend, there are plenty of options for completing your mile and having fun while you do it!

This is a family day, and there will be a delicious BBQ and children's entertainment to ensure that everyone has a great time, whether you are the finely honed athlete about to tackle a mile of skipping, or just there to watch the antics and socialise with friends.

The Manic Marafun will be held on the 24^th August and is open to everyone.  To take part in the Marafun itself there is a registration fee of just £10 for adults and £1 for children, so now's the time to dream up a suitably 'Manic' way of completing your mile and sign up! 

To find out more and register for this event simply visit http://www.limbpower.com/events/

Interested in £4 million?

The Health Foundation wants to make care safer by closing the gap between best practice and current delivery of care. 

We have £4 million on offer to support up to nine project teams to implement and evaluate tested, evidence-based patient safety interventions at scale. 

Types of project could include (but are not limited to):

• approaches to build skills in improving patient safety
• interventions to improve reliability of clinical care
• creating the conditions for the delivery of safer care.

Applicants will need to demonstrate a strong track record in designing, delivering and evaluating improvement projects. 

Due to the range of skills and experience required, we anticipate applications will come from groups of organisations working together. The skills required include quality improvement, evaluation and clinical/service expertise. 

Projects will also need to include an organisation that can influence wider practice and opinion. 

Interested? 

Applications open on 3 June 2013 and close at 12 noon on 23 September 2013. 

Visit www.health.org.uk/ctgptsafety to find out more. 

An Introduction to Podiatric Medicine for Healthcare Professionals Saturday 21st September 2013

For further information on the 'An Introduction to Podiatric Medicine for Healthcare Professionals' BAPO Short Course please follow the link below: Further Information

AFOs Improve Balance Confidence in Poststroke Hemiplegia Patients

Researchers at Northwestern University Prosthetics-Orthotics Center (NUPOC), Chicago, Illinois, and the U.S. Department of Veterans Affairs (VA) have found that AFO use improves balance confidence in patients with chronic poststroke hemiplegia.

http://www.oandp.com/articles/NEWS_2013-06-28_02.asp

HCPC professional indemnity cover and registration

EU directive 2011/24/EU sets about member states being responsible for high quality care and as a result each state must have a mechanism to ensure that patients are protected from the event of harm.  In the UK this will mean that all healthcare professionals will have Professional Indemnity Insurance in place by Friday 25^th October 2013.   Cover via an employer's indemnity arrangements is sufficient to meet requirement.   NHS employees should be covered under the clinical negligence scheme (CNS).  Sub contracted companies should hold sufficient arrangements.  Likewise, individuals who practice independently must hold cover.  The regulated professional must ensure that their indemnity arrangements in place are appropriate for the nature of their work that they undertake.   Voluntary work and Good Samaritan acts are not covered by employer insurance.   Healthcare professionals do not need reciprocal individual insurance. Vicarious liability is sufficient under this indemnity arrangement. 

In situations were persons are seen to be working outside their perceived scope of practice, it is difficult to avoid vicarious liability unless practitioner steps outside scope in areas of clear cut situations where policies are in place. 

Consultation on HCPC guidance for registrants launched on 10th June and closes on 2 August 2013 and can be found on the HCPC website.   http://www.hpc-uk.org/aboutus/consultations/index.asp?id=158 Guidance will then be published in September and sets out the responsibilities of a registrant, information about professional indemnity cover, how registrants can meet the requirement and how the HCPC will check that the cover is in place.  The requirement will be introduced in October 2013 and will be of a self-declaration upon renewal.  The HCPC will start checking cover is in place from 1 April 2014.  Failure to ensure appropriate cover is in place may mean administrative removal from the registrar or referral to fitness to practice.  

If you use insurance provided through your BAPO membership, it is still up to the individual registrant to provide the HCPC with details of indemnity insurance.  If you require Policy details, please contact the Secretariat. High-risk practice such as private work with sports persons or models will bring about increased risk and must be disclosed as an area of work.  All disclosures must be disclosed to insurers.  Area of practice is important when considering insurance and not scope of practice. 

 

NICE has updated its guidelines on falls

Healthcare professionals should consider patients aged 65 or older, and those aged over 50 with underlying conditions such as stroke, at high risk of falling while in hospital care, according to updated guidelines from NICE.

Falling is the leading cause of injury-related admissions to hospital in those over 65, and costs the NHS an estimated £2.3 billion per year.

A number of falls occur in hospitals, with nearly 209,000 reported between 1 October and 30 September 2012.

While many who fall only experience minor cuts or bruises, over the past year 90 people died, and around 900 experienced hip fractures and head injuries as a result of falls.

NICE has updated its guidelines on falls, to help reduce the number of older people who are falling over in hospitals.

NICE says that certain groups of inpatients should be regarded as being at risk of falling in hospital. These include all patients aged 65 years or older, and those aged 50 to 64 years who are judged by a clinician to be at higher risk of falling because of an underlying condition such as dementia or stroke.

For these patients, aspects of the inpatient environment that could affect their risk of falling should be systematically identified and addressed. These include flooring, lighting, furniture and fittings such as hand holds.

Healthcare professionals should also consider a multifactorial assessment and multifactorial intervention for patients at risk of falling in hospital.

These assessments should identify a patient's individual risk factors for falling in hospital that can be treated, improved or managed during their expected stay.

Such risk factors may include cognitive impairment, continence problems, a history of falls, postural instability and visual impairment.

Healthcare professionals should ensure that any multifactorial intervention carried out should promptly address the patient's identified individual risk factors for falling in hospital, and take into account whether the risk factors can be improved managed or treated during the patient's expected stay.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Falling over is a serious problem in hospitals, and unfortunately their likelihood increases with age as people become frailer. They can cause distress, pain, injury, a loss of confidence and independence, and in some cases, death."

He added: "While it would be virtually impossible to prevent all hospital falls from happening, our guideline calls for doctors and nurses to address the issues that will reduce the risk of their patients suffering avoidable harm. No two patients are the same and so a "one size fits all" approach will not work."

Michelle Mitchell, Director General of Age UK said: "The consequences of a fall in later life can be physically and emotionally devastating, potentially resulting in loss of mobility, independence and confidence.

"In addition to the pain caused to the individual, falls cost around £6 million a day in hospital and social care costs to treat."

He added: "Implementing these new guidelines to reduce falls in hospitals must be a priority for our health service, not only to improve patient safety, but to help save precious NHS resources."

A kinematic description of dynamic midfoot break in children using a multi-segment foot model

Jessica D. Maurer, Valerie Ward, Tanja A. Mayson, Karen R. Davies, Christine M. Alvarez, Richard D. Beauchamp, Alec H. Black

Gait & Posture, Volume 38, Issue 2 , Pages 287-292, June 2013

Abstract 

Midfoot break (MFB) is a foot deformity that occurs most commonly in children with cerebral palsy (CP), but may also affect children with other developmental disorders. Dynamic MFB develops because the muscles that cross the ankle joint are hypertonic, resulting in a breakdown and dysfunction of the bones within the foot. In turn, this creates excessive motion at the midfoot. With the resulting inefficient lever arm, the foot is then unable to push off the ground effectively, resulting in an inadequate and painful gait pattern. Currently, there is no standard quantitative method for detecting early stages of MFB, which would allow early intervention before further breakdown occurs. The first step in developing an objective tool for early MFB diagnosis is to examine the difference in dynamic function between a foot with MFB and a typical foot. Therefore, the main purpose of this study was to compare the differences in foot motion between children with MFB and children with typical feet (Controls) using a multi-segment kinematic foot model. We found that children with MFB had a significant decrease in peak ankle dorsiflexion compared to Controls (1.3±6.4° versus 8.6±3.4°) and a significant increase in peak midfoot dorsiflexion compared to Controls (15.2±4.9° versus 6.4±1.9°). This study may help clinicians track the progression of MFB and help standardize treatment recommendations for children with this type of foot deformity.

http://www.gaitposture.com/article/S0966-6362(12)00457-2/abstract?elsca1=etoc&elsca2=email&elsca3=0966-6362_201306_38_2&elsca4=elsevier

Conference 2013 Photographs

BAPO have a collection of around 500 photographs taken at this years conference.  We have now placed these in an online Gallery for you to see.  Please click the link to view the photographs.

http://files.bapo-online.com/gallery/?Conference

Short Course: Paediatric Gait Analysis and Orthotic Management: A Segmental Kinematic Approach

Paediatric Gait Analysis and Orthotic Management:
A Segmental Kinematic Approach
8th & 9th November 2013
SALTS Healthcare, Birmingham

For further information on the 'Paediatric Gait Analysis and Orthotic Managemnet: A Segmental Kinematic Approach' BAPO Short Course please follow the link below:

Further Information

Please note that the cancellation date of this course is 25th October 2013.  If you wish to book a place on the BAPO short course then please do so at your earliest convenience.

How is the new NHS structured?

The Kings Fund have released a simplified flow diagram of the new NHS structure which can be found here

http://www.slideshare.net/kingsfund/nhs-structures

Prosthetics service for veterans launched

A NATIONAL prosthetics service has been launched for veteran military amputees.

The service will provide amputees with advanced prosthetics designed to function as much like a natural limb as possible. It will also act as a dedicated point of access to services including limb fitting and rehabilitation.

It is estimated there are about 66 military amputees in Scotland, and ministers yesterday met one of them, Steven Richardson from East Lothian.

He lost both legs and some fingers on both hands after he stood on an explosive device during a tour in the Nad-e-Ali district of Afghanistan in 2010.

Health secretary Alex Neil said: "It is only right our veterans, who have risked their lives for this country, receive world-class services through our NHS.

"Scotland is already leading the way in prosthetic care and this new specialist service is a fantastic example of the NHS using innovative technologies to deliver 21st-century healthcare."

The service has been launched by the Scottish Government following recommendations in a report by Dr Andrew Murrison on NHS prosthetics for veterans, particularly those from recent conflicts in Iraq and Afghanistan.

The UK government asked Dr Murrison, a Tory MP, to review prosthetic services after concerns were raised by some charities the NHS may not provide services to the same standard as the Defence Medical Service provided by the Ministry of Defence.

Ian Waller, of the British Limbless Ex-Service Men's Association, said: "We are encouraged by the clear message this sends to our members in Scotland; that their needs have been recognised, considered and are being addressed."

Source: http://www.scotsman.com/news/health/prosthetics-service-for-veterans-launched-1-2976943