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

Cost Benefit Analysis of Knee Prostheses

A study is being conducted at Imperial College Business School. The purpose of this study is to analyse the costs and benefits of different types of leg prostheses used by clients in the UK.

The survey is directed to patients who have undergone UNILATERAL ABOVE-KNEE AMPUTATION (only in one leg).

The RESULTS of this study will help provide evidence-based research to support the campaign for more funding to be made available for microprocessor knees in the UK.

The survey can be completed in 10-15 minutes and can be found on the following link https://iclbusiness.eu.qualtrics.com/SE/?SID=SV_7QdSoPKMkQkHqhD

Your response will be confidential. You will be assigned a participant number and only these numbers will appear in subsequent analyses of the data.

If you do not wish to answer a particular question please leave it blank and you can withdraw from the study at anytime.

By completing the survey, you acknowledge that you have read this information and agree to participate in this research.

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

Please note that the cancellation date of this course is 24th August 2013.  If you wish to book a place on the BAPO short course then please do so at your earliest convenience.

NHS e-Referral Service vision - making paperless referrals a reality

What might an NHS e-Referral Service look like in the future?

The needs of patients and professionals will be foremost in designing the new service, which will include support for enhanced functionality and usability for delivering some or all of the following:

Improved integration and usability

Referral management support

Any to any referrals

Linked appointments

Follow-up appointments

Self referrals

Enhanced reporting capability

Electronic communications

http://systems.hscic.gov.uk/ers

Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes

J.D. Chapman, S. Preece, B. Braunstein, A. Höhne, C.J. Nester, P. Brueggemann, S. Hutchins

Abstract 
Background

There is no consensus on the precise rocker shoe outsole design that will optimally reduce plantar pressure in people with diabetes. This study aimed to understand how peak plantar pressure is influenced by systematically varying three design features which characterise a curved rocker shoe: apex angle, apex position and rocker angle.

Methods

A total of 12 different rocker shoe designs, spanning a range of each of the three design features, were tested in 24 people with diabetes and 24 healthy participants. Each subject also wore a flexible control shoe. Peak plantar pressure, in four anatomical regions, was recorded for each of the 13 shoes during walking at a controlled speed.

Findings

There were a number of significant main effects for each of the three design features, however, the precise effect of each feature varied between the different regions. The results demonstrated maximum pressure reduction in the 2nd–4th metatarsal regions (39%) but that lower rocker angles (<20°) and anterior apex positions (>60% shoe length) should be avoided for this region. The effect of apex angle was most pronounced in the 1st metatarsophalangeal region with a clear decrease in pressure as the apex angle was increased to 100°.

Interpretation

We suggest that an outsole design with a 95° apex angle, apex position at 60% of shoe length and 20° rocker angle may achieve an optimal balance for offloading different regions of the forefoot. However, future studies incorporating additional design feature combinations, on high risk patients, are required to make definitive recommendations.

http://www.clinbiomech.com/article/S0268-0033(13)00114-9/abstract

Physiotherapy to Complement Orthotic Treatment Saturday 12th October 2013 Staffordshire University

Please click for Further Information on the 'Pysiotherapy to Complement Orthotic Treatment' BAPO Short Course.

HCPC launches consultation on guidance for professional indemnity cover and registration

News release 

The Health and Care Professions Council (HCPC) has today launched an eight week consultation to seek the views of stakeholders on guidance for registrants in relation to professional indemnity cover and registration. 

The Government are proposing that all health professionals must hold professional indemnity cover as a condition of registration. This is subject to parliamentary approval and will apply to all of the professions regulated by the HCPC with the exception of social workers in England*. This is because these 15 professions are considered to be 'healthcare professions' under the terms of the European Directive 2011/24/EU on cross-border healthcare. 

We anticipate that the majority of our registrants will already be able to meet these requirements as they will be indemnified either through their employer, a professional body, directly with an insurer or a combination of these. However, it is important that registrants ensure that they have cover in place that is appropriate for their practice. 

Subject to the legislative timetable, cover must be in place by Friday 25 October 2013. From 1 April 2014 new applicants to the Register and those renewing their registration will be required to complete a professional declaration. Failure to hold appropriate cover will mean an individual will not have their registration renewed or, in the case of new applicants, will not be registered by us.

Louise Hart, Director of Council and Committee Services commented;

"It is important that professionals are aware of their responsibilities to have appropriate indemnity cover and to take steps to ensure they meet this new requirement of registration.

"The draft guidance we have produced outlines what professionals need to know about their responsibilities and provides detailed information about professional indemnity, how they can meet this requirement and how the HCPC will check that cover is in place.

"We are now seeking views on this draft guidance and would welcome feedback from professionals on our Register as well as employers and other stakeholders who may be affected by this new requirement."

The consultation will run from 10 June 2013 until 2 August 2013 and can be found on the following link https://www.research.net/s/consultationonguidanceforPIIrequirement

Gene Associated With Adolescent-Onset Scoliosis Identified

Researchers at the RIKEN Center for Integrative Medical Sciences in Japan have identified a gene associated with adolescent idiopathic scoliosis (AIS). This is the first time that any gene or specific cause has been linked to this form of scoliosis which affects adolescents. Scoliosis is a skeletal disease that causes the spine to become deformed: the spine of an individual suffering from scoliosis may look like the shape of an "S" or a "C" when viewed on an X-ray. AIS, as the name suggests, is a form of scoliosis that has its onset in adolescence, usually during the puberty growth period. Although the condition is called idiopathic because its cause is unknown, scientists have suspected that genetics may play a part in causing AIS. In their study, published in Nature Genetics, the team from RIKEN sought to uncover genetic risk factors for AIS by studying the genomes over 1,800 patients who suffer from AIS and almost 26,000 unaffected individuals in the Japanese population.

From their genome-wide analysis, the researchers identified variants of a gene, GPR126, that were

significantly associated with a higher risk for developing AIS. The team subsequently confirmed

that GPR126 is also linked to AIS susceptibility in the Han Chinese and Caucasian populations.

Experiments further showed that the GPR126 gene product, which is known to play a role in human

height and trunk length, promotes growth and bone tissue formation in spine development. These findings suggest that genetic alterations in GPR126 may affect both AIS susceptibility and height by causing abnormal spinal development and growth. 

The article can be found at: Kou et al. (2013) Genetic Variants In GPR126 Are Associated With Adolescent Idiopathic Scoliosis.

http://www.asianscientist.com/health-medicine/gene-adolescent-onset-scoliosis-identified-2013/

The Department of Health has announced a £4m fund to improve the way diseases are diagnosed.

This money will fund research that looks at the way a number of different diseases are diagnosed, so patients can access the best available treatments more quickly.

The National Institute for Health Research (NIHR) will share the funding across four NHS organisations in London, Leeds, Newcastle and Oxford. These places will become national centres of expertise called NIHR diagnostic evidence co-operatives.

These centres will promote research into medical tests used to diagnose things like cancer, liver and respiratory diseases, so patients across the NHS can benefit from advances in technology. More .....