Dose–response effects of customised foot orthoses on lower limb kinematics and kinetics in pronated foot type

S Telfer, M Abbott, MM Steultjens, J Woodburn - Journal of Biomechanics, 2013

Abstract 

Despite the widespread use of customised foot orthoses (FOs) for the pronated foot type there is a lack of reliable information on the dose–response effect on lower limb mechanics. This study investigated these effects in subjects with normal and pronated foot types. Customised FOs were administered to 12 participants with symptomatic pronated foot type and 12 age and gender matched controls. A computer-aided design (CAD) software was used to design nine FOs per participant with dose incrementally changed by varying only the rearfoot post angle. This was done in 2° increments from 6° lateral to 10° medial posting. A 3D printing method was used to manufacture the FOs. Quantification of the dose–response effect was performed using three-dimensional gait analyses for selected rearfoot and knee kinematics and kinetics. Under these experimental conditions, significant and linear effects of posting were seen for the peak (p<0.001) and mean (p<0.001) rearfoot eversions, peak (p=0.003) and mean (p<0.001) ankle eversion moments and peak (p=0.017) and mean (p=0.005) knee adduction moment variables. Group effects were observed for the peak (p=0.007) and mean (p=0.007) forefoot abduction and for the peak (p=0.007) knee adduction moment. A significant interaction between posting and group was seen for internal tibial rotation (p=0.004). These data indicate that a dose–response effect, with a linear trend for both the rearfoot and knee, exists for customised FOs used to treat pronated foot type.

http://www.jbiomech.com/article/S0021-9290(13)00166-8/abstract

The effectiveness of footwear as an intervention to prevent or to reduce biomechanical risk factors associated with diabetic foot ulceration: A systematic review

A Healy, R Naemi, N Chockalingam - Journal of Diabetes and its Complications

Abstract 

Aim

Footwear interventions are used within clinical practice in an effort to reduce ulcerations however the effectiveness of these interventions is unclear. The aim of this paper was to conduct a systematic review which examined the effectiveness of footwear as an intervention for prevention of diabetic foot ulcers or the reduction of biomechanical risk factors for ulceration and to discuss the quality and interpret the findings of research to date.

Methods

The CINAHL, Medline and Cochrane Register of Controlled Trials databases were searched with 12 articles identified for review.

Results

The majority of these studies were cross sectional and examined the effect of different footwear conditions on plantar pressure measurements. Factors which influenced study findings such as participant selection, measurement and analysis techniques, footwear design and compliance are discussed and recommendations for future studies are provided.

Conclusions

No research to date has examined the effectiveness of footwear in preventing ulceration. Conflicting findings are reported on the effective of footwear interventions to prevent reulceration. While the use of rocker sole footwear and custom orthoses in plantar pressure reduction are supported in cross sectional studies, longitudinal studies are required to confirm their benefit.

http://www.jdcjournal.com/article/S1056-8727(13)00056-1/abstract

Scoliosis—treatment indications according to current evidence

HR Weiss, M Moramarco

Abstract

Introduction

Long-term follow-ups of untreated patients with adolescent idiopathic 

scoliosis (AIS) indicate that the consequences of AIS over a lifetime are 

minimal, sometimes moderate in more severe cases, however, never 

life-threatening. In light of these findings, the historical indications 

for treatment should be investigated according to current evidence.

Recent reviews have been investigated for their contribution to 

evidence in the field of scoliosis treatment—especially the impact of 

the results obtained on the historical modes of treatment. 

From these findings, we may conclude that there is promising 

evidence for the application of physiotherapy in the treatment of scoliosis in children or adolescents and for adults with curvatures exceeding 35° 

Cobb. There is a stronger evidence for the application of (hard) braces 

during growth. There is no evidence for spinal fusion surgery for AIS. The 

use of surgery should be limited in patients with scoliosis of other origin. This critical review discusses the treatment methods for scoliosis.

Conclusion

There is some evidence for the use of physiotherapy as a treatment for 

scoliosis. There is strong evidence for the use of hard braces during growth. 

http://www.oapublishinglondon.com/images/article/pdf/1368523536.pdf

Foot Drop Stimulation Versus Ankle Foot Orthosis After Stroke - 30-Week Outcomes

Patricia M. Kluding, PhD, 

Kari Dunning, PhD, 

Michael W. O'Dell, MD,

Samuel S. Wu, PhD, 

Jivan Ginosian, MS, 

Jody Feld, DPT and

Keith McBride, DPT

Abstract

Background and Purpose—Drop foot after stroke may be addressed using an ankle foot orthosis (AFO) or a foot drop stimulator (FDS). The Functional Ambulation: Standard Treatment versus Electric Stimulation Therapy (FASTEST) trial was a multicenter, randomized, single-blinded trial comparing FDS and AFO for drop foot among people ≥3 months after stroke with gait speed ≤0.8 m/s.

Methods—Participants (n=197; 79 females and 118 males; 61.14±11.61 years of age; time after stroke 4.55±4.72 years) were randomized to 30 weeks of either FDS or a standard AFO. Eight dose-matched physical therapy sessions were provided to both groups during the first 6 weeks of the trial.

Results—There was significant improvement within both groups from baseline to 30 weeks in comfortable gait speed (95% confidence interval for mean change, 0.11–0.17 m/s for FDS and 0.12–0.18 m/s for AFO) and fast gait speed. However, no significant differences in gait speed were found in the between-group comparisons. Secondary outcomes (standard measures of body structure and function, activity, and participation) improved significantly in both groups, whereas user satisfaction was significantly higher in the FDS group than in the control group.

Conclusions—Using either an FDS or an AFO for 30 weeks yielded clinically and statistically significant improvements in gait speed and other functional outcomes. User satisfaction was higher in the FDS group. Although both groups did receive intervention, this large clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinically meaningful benefit even years after stroke.

http://stroke.ahajournals.org/content/early/2013/05/02/STROKEAHA.111.000334.abstract

A pilot study to assess the effectiveness of orthotic insoles on the reduction of plantar soft tissue strain

• Musab Ibrahim
, 
• Rana El Hilaly
, 
• Mona Taher
, 
• Ahmed Morsy

Clinical Biomechanics

Abstract 

Background

Plantar ulcers pose a frequent serious complication in the neuropathic foot. Previous studies suggested that ulcer initiation occurs within the plantar soft tissue rather than on the plantar surface. This study investigated the effectiveness of different shaped silicone insoles on the reduction of both plantar soft tissue strain and pressure. The authors have found no previous experimental studies on the effectiveness of insole shape on reducing plantar soft tissue strain during standing.

Methods

A custom molded silicone insole which allowed passage of ultrasound to the plantar surface of the foot was prototyped for this study. Soft tissue strain was computed from soft tissue thickness measured using ultrasound in five conditions: unloaded, barefoot, wearing a prefabricated silicone insole, wearing the custom molded silicone insole alone then with a metatarsal pad. Plantar pressure was measured for the same conditions.

Findings

The custom molded insole was found to significantly reduce soft tissue strain and plantar pressure relative to both the barefoot condition and the prefabricated insole under the second and third metatarsal heads. The metatarsal pad was found to significantly reduce soft tissue strain but not significantly affect plantar pressure.

Interpretation

A custom molded silicone insole can effectively reduce both soft tissue strain and plantar pressure and is thus preferable to a prefabricated insole. It is suggested that quantifying the reduction of soft tissue strain is an essential design requirement for orthotic insoles since plantar pressure may not be a sufficient indicator of the effectiveness of an insole in preventing ulcer initiation.

Source: http://www.clinbiomech.com/article/S0268-0033(12)00222-7/abstract

Brain implant points to advanced prosthetics

A compact, self-contained sensor recorded and transmitted brain activity data wirelessly for more than a year in early stage animal tests, according to a study funded by the US National Institutes of Health.

In addition to allowing for more natural studies of brain activity in moving subjects, this implantable device is claimed to represent a potential major step toward cord-free control of advanced prosthetics that move with the power of thought. The report is in the April 2013 issue of the Journal of Neural Engineering.

For people who have sustained paralysis or limb amputation, rehabilitation can be slow and frustrating because they have to learn a new way of doing things that the rest of us do without actively thinking about it,' said Grace Peng, Ph.D., who oversees the Rehabilitation Engineering Program of the National Institute of Biomedical Imaging and Bioengineering (NIBIB), part of NIH. 'Brain-computer interfaces harness existing brain circuitry, which may offer a more intuitive rehab experience, and ultimately, a better quality of life for people who have already faced serious challenges.'

Read more: http://www.theengineer.co.uk/medical-and-healthcare/news/brain-implant-points-to-advanced-prosthetics/1015825.article#ixzz2OAFn0BWE

Drainpipe prosthetics in war torn Syria

Mr Qurashi Credit: Dudley Group NHS Foundation Trust

A doctor from Dudley has returned from Syria where he has been fitting prosthetic limbs made from drainpipes to war victims.

Mr Qurashi, who works at Russells Hall Hospital, occupied a makeshift clinic and workshop helping men, women and children who lost limbs during the two-year war that has so far claimed thousands of lives.

A Turkish businessman has donated the drainpipes which are melted down at high heat in an oven and moulded against a plaster cast of the amputated leg. They are then fitted into place with metal pins and leather straps.

The artificial feet are made from recycled rubber.

Source: http://www.itv.com/news/central/topic/prosthetics/

Effect of different orthotic concepts as first line treatment of plantar fasciitis

• Markus Walther, MD, PhD^a, , , , 
• Bernd Kratschmer, MD^b, 
• Joachim Verschl, MD^b, 
• Christoph Volkering, MD^a, 
• Sebastian Altenberger, MD^a, 
• Stefanie Kriegelstein, MD^a, 
• Marc Hilgers, MD, PhD^c

• ^a Department of Foot and Ankle Surgery, Schoen Klinik Munich Harlaching, Harlachinger Strasse 51, 81547 Munich, Germany¹
• ^b Outpatient Clinic for Orthopedic and Trauma Surgery, Altstadtring 6, 91161 Hilpoltstein, Germany
• ^c Florida Orthopaedics Institute, 13020 Telecom Parkway North, Tampa, FL 33637, USA

• http://dx.doi.org/10.1016/j.fas.2012.12.008, 

Abstract

Background

Evaluation of the effectiveness of three different types of prefabricated foot orthotics in the treatment of plantar fasciitis.

Methods

Prospective, randomized head-to-head trial in 30 adults (21 women, 9 men) with plantar fasciitis without any anatomic alterations. Three different prefabricated orthotics were tested (thin, non supportive orthotic (NO); soft supportive foam orthotic (FO); foam covered rigid self-supporting plastic orthotic (PO)). The follow up was 3 weeks. Main outcome measures were maximum and average pain (VAS), duration of pain per day, walking distance and subjective comfort.

Results

There was no significant effect of NO on maximal pain and average pain. FO and PO had a significant effect on pain levels (p < 0.05) whereas PO was superior concerning pain reduction and the time until the onset of effect (p < 0.05).

Conclusions

PO are superior regarding pain reduction and pain free time when compared to FO. NO did not demonstrate a significant effect in the test setup used.

http://www.sciencedirect.com/science/article/pii/S1268773113000209

Prosthetics study to improve mobility of amputees

Research by the University of Salford, University of Manchester and Blatchford's Endolite Technology Centre will help to enhance the mobility of people with above-knee amputations by improving the energy efficiency of prosthetic legs.

When walking with a single prosthetic leg, above-knee amputees typically use up to 60% more energy than people who are able-bodied, causing fatigue and a 40% slower walking speed. These difficulties can hinder an amputee's mobility and, as a result, affect their quality of life.

The energy storage and return capabilities of prosthetic legs are crucial to improving an amputee's gait and mobility, but most prostheses only store and return significant energy below the knee and in an uncontrolled way.

To overcome these problems the team of engineers and prosthetists will explore the potential for using hydraulic technology to harvest and store energy from the parts of the prosthesis that absorb power, and then return that energy to the parts that do useful propulsive work.

The results will be used to develop new prosthetic leg designs which have increased functionality and require less energy from the amputee.

http://www.salford.ac.uk/home-page/news/2013/prosthetics-study-to-improve-mobility-of-amputees

NHS Change Day – a single day of collective action to demonstrate how small changes can have a big impact

On the 13 March 2013 NHS Change Day will bring together the individual creativity, energy   and innovative thinking of thousands of NHS staff from across clinical and non-clinical areas   of work, in a single day of collective action to improve care for patients, their families and   their carers.   Change Day is an NHS grassroots initiative devised and driven by new young and emergent   clinical and managerial leaders from primary and secondary care across the NHS in England,   who want to make this call to action the single largest simultaneous improvement event in   the NHS.     It is an ambitious programme of activities aimed at galvanising and engaging the frontline in   the process of improvement through individuals and teams pledging to make a change in   their practice which will improve patient experience and/or clinical outcomes by spreading   and adopting best practice and championing innovation. This will be a country wide event   covering the whole of the UK and will coincide with Healthcare Innovation Expo at Excel in   the same day.          The idea of NHS Change Day is create a mass movement of people working in the NHS   demonstrating the difference they can make - by one simple act – and proving that large   scale improvement is possible in the NHS. The aim is for 65,000 people to take part, 65   being the number of years the NHS has been in existence.          Those who wish to take part can go to the NHS Change Day website at   http://www.changemodel.nhs.uk/changeday and make their pledge online, join in the   discussions on the forum and become part of the growing list of active supporters and   organisations taking part on the day. 

Launch of consultation on legislation on indemnity insurance

A consultation is launched on legislation that would mean all regulated healthcare professionals have to hold indemnity or insurance to practise.

The consultation will run from 22 February to 17 May 2013 on draft regulations on the requirement for all regulated healthcare professionals to hold an insurance or indemnity arrangement as a condition of their registration with the relevant regulatory body.

The vast majority of healthcare professionals are already covered by their employer's arrangements. In the first instance, it will be for each individual healthcare professional to assure themselves that they are covered by an insurance or indemnity arrangement appropriate to their scope of practice.

Health Minister Dr Dan Poulter said:

"We believe all regulated healthcare professionals should hold insurance or indemnity to ensure the patients they treat are fully protected if things don't go according to plan.

"We are changing the law to make sure that this is the case. This will mean that in the rare cases where a patient suffers harm as a result of negligence, they are able to seek compensation.

"This should increase patient confidence and improve safety overall."

The department has asked some specific questions in the consultation document but please provide comments on any aspect of the consultation package.

There are a number of other provisions of the directive which have yet to be transposed into UK law and which will be consulted upon separately. The UK is required to be compliant with the directive from 25 October 2013. The department is undertaking the consultation on behalf of all UK health administrations.

Legislation in respect of the Pharmaceutical Society of Northern Ireland remains the responsibility of the Northern Ireland legislature and is subject to a separate consultation in Northern Ireland.

• respond online
• read the consultation document
• read the draft order
• read the impact assessment
• download the impact assessment supporting spreadsheet
• read the equality analysis
• download the consultation response document

http://www.dh.gov.uk/health/2013/02/indemnity-i/

BAPO Conference 2013 Social Programme

BAPO CONFERENCE & EXHIBITION 2013 SOCIAL PROGRAMME Please see below for details on the full Social Programme for Conference 2013 weekend:

BAPO CONFERENCE & EXHIBITION 2013 TIMETABLE

Click on the links below for details of what's on and when

Friday 22 March 2013
http://gallery.mailchimp.com/e99b59101e344f80e38400f12/files/Friday_Programme_Timetable.pdf

Saturday 23 & Sunday 24 March 2013
http://gallery.mailchimp.com/e99b59101e344f80e38400f12/files/Saturday_Sunday_programme_Timetable.pdf

BAPO 2013 Call for Posters - Chance to win £100!

For full details on how to submit a poster for BAPO Conference & Exhibition 2013 please see below, further details at www.bapo.com

Printed Prosthetics

Traditionally, amputees have been offered one-size-fits-all prosthetics – functional but not particularly attractive. Now technology is blurring the line between medical devices and sculpture.

http://www.euronews.com/2013/02/13/printed-prosthetics/

 

CAD tools for designing shoe lasts for people with diabetes

J Antonio Bernabeu, M Germani, M Mandolini… - Computer-Aided Design, 2013

... 2.3. Orienting and measuring the foot and the last. The InfoHorma (IH) software aims to extract
standard measurements from the geometrical shapes of digitised 3D feet or last models after
they have been aligned. ... 2.4. Modifying last geometry to ensure optimal foot–last fitting. ...

http://www.sciencedirect.com/science/article/pii/S001044851300002X 

Improvements announced in NHS prosthetic care for war veterans

NHS services across the country are set to benefit from additional funding to improve prosthetic and rehabilitation services for ex-servicemen and women.

The government is making £11 million available over the next 2 years to ensure veterans are able to access a high level of prosthetic and rehabilitation care.

Nine NHS facilities across the country will receive a share of up to £6.7 million of the funding. They will be able to use this specifically to access the latest technology and provide the highest quality of prosthetic care for veteran amputees. The centres are:

• Bristol: Disablement Services Centre, North Bristol NHS Trust
• Leicester: Leicester Specialist Mobility Centre, provided by Blatchford Clinical Services on behalf of PCTs
• Sheffield: Mobility and Specialised Rehabilitation Centre, Northern General Hospital
• Carlisle: Disablement Services Centre, Cumberland Infirmary, North Cumbria University Hospitals NHS Trust
• Preston: Specialist Mobility & Rehabilitation Centre, Lancashire Teaching Hospitals NHS Foundation Trust
• Stanmore: Stanmore Prosthetic Rehabilitation Unit, Royal National Orthopaedic Hospital Trust
• Portsmouth: Prosthetic Regional Rehabilitation Department, Portsmouth Hospitals NHS Trust
• Birmingham: West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Trust
• Cambridge: Addenbrooke's Rehabilitation Clinic, Cambridge University Hospitals NHS Foundation Trust

Other services will benefit too, with a £1million fund to ensure that all prosthetics services across England improve. The remainder will go towards providing prosthetics.

Announcing the funding, Health Minister Dr Dan Poulter said:

"Ex-servicemen and women who have been injured in the line of duty deserve the very best possible care from the NHS.  This is why we are making more funding available to improve veterans' prosthetic limb services – and £22 million in total between 2010 and 2015 to support veterans' physical and mental health. 

"We want to ensure that our Armed Forces veterans have access to the very best healthcare services at specialist prosthetic and rehabilitation centres across the country. In time, these NHS centres will achieve the same high standards of care for veterans that are offered by Armed Forces rehabilitation centres, such as Headley Court." 

Today's announcement is in response to recommendations made by Dr Andrew Murrison MP in a report, commissioned by the Prime Minister, about the provision of prosthetics for military amputees.

Dr Murrison recommended that a small number of multi-disciplinary centres should provide specialist prosthetic and rehabilitation services in England to ensure veterans have access to a similar, high quality of care to that which the Armed Forces provides.

Dr Jeff Lindsay, a Consultant in Amputee Rehabilitation at the West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Trust, said:

"Our aim is for ex-service men and women to maintain their level of independence, function and capabilities as they move from the military into civilian life. 

"The additional funding will enable us to offer the highest possible standards of prosthetic provision and care for these brave men and women, as they leave the armed forces and their care is transferred to the NHS.

"Furthermore, the additional funding will help to enhance both the knowledge and skills of our expert staff and improve available facilities for the benefit all patients, both ex-servicemen and women and civilians alike." 

The additional funding and improvements that this will bring will mean that civilian amputees will also be able to benefit from advanced care in centres across the NHS in England.

The NHS Commissioning Board will work with military charities and the NHS to finalise the amount each service will receive.

Clinical Responsibility and the Healthcare Professional BAPO short course 11th May 2013 BAPO Secretariat

Due to technical difficulties please use the link below for further information on the 'Clinical Responsibility and the Healthcare Professional' BAPO short course.

Further Information

Clinical Responsibility And The Healthcare Professional - (Medico Legal) - BAPO Short Course on Saturday 11th May 2013

held at BAPO Secretariat Unit 64, Sir James Clark Building Abbeymill Business Centre Paisley PA1 1TJ

For further information on the Clinicial Responsibility And The Healthcare Professional BAPO Short Course, please follow link below: http://gallery.mailchimp.com/e99b59101e344f80e38400f12/files/Flyer_Medico_Legal_NEW_FORMAT_11.02.13.docx

NHSAcronym – the handy app at your fingertips

Download the new NHSAcronym app to your iPhone or iPad so you have the definition of over 500 commonly used acronyms in the NHS at your fingertips. Just search 'NHSAcronym' in the iTunes app store.