Sunday, August 26, 2007
The researcher vs the clincian
This dichotomy keeps coming up.
Most recently in this Podiatry Arena thread:
No evidence for foot orthoses in children (notice the questions by clinicians directed at the researchers about the type of foot orthotics used)
Previously it came up in this thread:
Effectiveness of Foot Orthoses to Treat Plantar Fasciitis (notice the really poor understanding by clinicians of just what is a randomised controlled trial)
In a post in this thread: The 5 great FALLACIES of podiatric biomechanics, Kevin Kirby posted: "Researchers will continue to misrepresent the effectiveness of prescription foot orthoses until they understand the concept that skilled orthosis practitioners do not simply hand out cookie-cutter orthoses to patients without needing to occasionally adjust them to improve patient symptoms and improve gait function."
Researchers often complain that clincians "just don't get it".
Clincians often complain that researchers "just don't get it".
I am a researcher and a clincian and I think "I get it". What are we going to do about this? How can researchers conduct clinical trials so that clinicians can "get it". How can clinicians get researchers to see where they are coming from so they can "get it"
What say you? Comments here
Most recently in this Podiatry Arena thread:
No evidence for foot orthoses in children (notice the questions by clinicians directed at the researchers about the type of foot orthotics used)
Previously it came up in this thread:
Effectiveness of Foot Orthoses to Treat Plantar Fasciitis (notice the really poor understanding by clinicians of just what is a randomised controlled trial)
In a post in this thread: The 5 great FALLACIES of podiatric biomechanics, Kevin Kirby posted: "Researchers will continue to misrepresent the effectiveness of prescription foot orthoses until they understand the concept that skilled orthosis practitioners do not simply hand out cookie-cutter orthoses to patients without needing to occasionally adjust them to improve patient symptoms and improve gait function."
Researchers often complain that clincians "just don't get it".
Clincians often complain that researchers "just don't get it".
I am a researcher and a clincian and I think "I get it". What are we going to do about this? How can researchers conduct clinical trials so that clinicians can "get it". How can clinicians get researchers to see where they are coming from so they can "get it"
What say you? Comments here
Wednesday, July 11, 2007
The 5 great FALLACIES of podiatric biomechanics
Adam asks:
"I've been refreshing my comprehension of pedal biomechanics of late and wondered if you had an opinion on what the 5 greatest mis-truths of this discipline are.In other words what concepts most people think/ assume are correct, that havn't yet been tested by science or are likely to be."
Read the responses.
"I've been refreshing my comprehension of pedal biomechanics of late and wondered if you had an opinion on what the 5 greatest mis-truths of this discipline are.In other words what concepts most people think/ assume are correct, that havn't yet been tested by science or are likely to be."
Read the responses.
Sunday, February 11, 2007
Gangastapod
For a different view of evidence based practice, check Gangstapod
Sunday, September 24, 2006
This study has generated a lot of good discussion:
Effectiveness of Foot Orthoses to Treat Plantar Fasciitis A Randomized Trial
Karl B. Landorf, PhD; Anne-Maree Keenan, MAppSc; Robert D. Herbert, PhD
Archives of Internal Medicine 2006;166(12), June 26:1305-1310.
"Background Plantar fasciitis is one of the most common foot complaints. It is often treated with foot orthoses; however, studies of the effects of orthoses are generally of poor quality, and to our knowledge, no trials have investigated long-term effectiveness. The aim of this trial was to evaluate the short- and long-term effectiveness of foot orthoses in the treatment of plantar fasciitis. Methods A pragmatic, participant-blinded, randomized trial was conducted from April 1999 to July 2001. The duration of follow-up for each participant was 12 months. One hundred and thirty-five participants with plantar fasciitis from the local community were recruited to a university-based clinic and were randomly allocated to receive a sham orthosis (soft, thin foam), a prefabricated orthosis (firm foam), or a customized orthosis (semirigid plastic). Results After 3 months of treatment, estimates of effects on pain and function favored the prefabricated and customized orthoses over the sham orthoses, although only the effects on function were statistically significant. Compared with sham orthoses, the mean pain score (scale, 0-100) was 8.7 points better for the prefabricated orthoses (95% confidence interval, –0.1 to 17.6; P = .05) and 7.4 points better for the customized orthoses (95% confidence interval, –1.4 to 16.2; P = .10). Compared with sham orthoses, the mean function score (scale, 0-100) was 8.4 points better for the prefabricated orthoses (95% confidence interval, 1.0-15.8; P = .03) and 7.5 points better for the customized orthoses (95% confidence interval, 0.3-14.7; P = .04). There were no significant effects on primary outcomes at the 12-month review. Conclusions Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device. The customized and prefabricated orthoses used in this trial have similar effectiveness in the treatment of plantar fasciitis."
Discussion here.
The next ePodiatry Newsletter is online.
Effectiveness of Foot Orthoses to Treat Plantar Fasciitis A Randomized Trial
Karl B. Landorf, PhD; Anne-Maree Keenan, MAppSc; Robert D. Herbert, PhD
Archives of Internal Medicine 2006;166(12), June 26:1305-1310.
"Background Plantar fasciitis is one of the most common foot complaints. It is often treated with foot orthoses; however, studies of the effects of orthoses are generally of poor quality, and to our knowledge, no trials have investigated long-term effectiveness. The aim of this trial was to evaluate the short- and long-term effectiveness of foot orthoses in the treatment of plantar fasciitis. Methods A pragmatic, participant-blinded, randomized trial was conducted from April 1999 to July 2001. The duration of follow-up for each participant was 12 months. One hundred and thirty-five participants with plantar fasciitis from the local community were recruited to a university-based clinic and were randomly allocated to receive a sham orthosis (soft, thin foam), a prefabricated orthosis (firm foam), or a customized orthosis (semirigid plastic). Results After 3 months of treatment, estimates of effects on pain and function favored the prefabricated and customized orthoses over the sham orthoses, although only the effects on function were statistically significant. Compared with sham orthoses, the mean pain score (scale, 0-100) was 8.7 points better for the prefabricated orthoses (95% confidence interval, –0.1 to 17.6; P = .05) and 7.4 points better for the customized orthoses (95% confidence interval, –1.4 to 16.2; P = .10). Compared with sham orthoses, the mean function score (scale, 0-100) was 8.4 points better for the prefabricated orthoses (95% confidence interval, 1.0-15.8; P = .03) and 7.5 points better for the customized orthoses (95% confidence interval, 0.3-14.7; P = .04). There were no significant effects on primary outcomes at the 12-month review. Conclusions Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device. The customized and prefabricated orthoses used in this trial have similar effectiveness in the treatment of plantar fasciitis."
Discussion here.
The next ePodiatry Newsletter is online.
Saturday, April 01, 2006
Newsletter updates
The next Podiatry Arena and ePodiatry Newsletters are now online.
Sunday, January 29, 2006
How important is debridement in onychomycosis?
This paper has generated some good discussion:
Study to determine the efficacy of Clotrimazole 1% cream for the treatment of onychomycosis in association with the mechanical reduction of the nail plate
"Onychomycosis is invasion of the nail by dermatophytes yeasts and moulds [Calderon RA, Hay RJ. Fungicidal activity of human neutrophils and monocytes on dermatophyte fungi Tri. Quinckeanum and Tri. Rubrum. Immunology 1986;61:289–95; Degreef H. Onychomycosis. Br J Clin Pract Syn Suppl 1990;71:91–7; Zaias N. Clinical manifestations of onychomycosis. Clin Exp Dermatol 1992;17(1):6–7]. Causative organisms include T. rubrum and T. mentagrophytes. Fungi invade the distal and lateral under surfaces of the nail. The prevalence of onychomycosis approximates to 5–10% of the population and is increasing significantly in recent years [Stutz A. Allylamine derivatives—a new class of active substances in antifungal chemotherapy. Angew Chem 1987;2:320–8].Clotrimazole 1% cream is the most commonly prescribed topical antifungal agent in the United Kingdom although its use on nails has not been widely documented. Past inefficiencies may be due to the thickness of the nail plate. The mechanical reduction of the nail minimises the nail as a barrier to the absorption of the cream and increases the permeability of the nail plate.Subjects were ambulant and healthy with no systemic medication, no past history of anti-fungal agents and an ankle-brachial index indicating sufficient circulation for healing to occur. The infecting organism was identified by microscopy and culture. A total of ninety-two infected nails were isolated over a four-year period. The age range was 60–78 years. Nails were drilled every 14 days by the same operator and the area of infection mapped. Clotrimazole 1% cream was applied twice daily during the trial period and the percentage clearance rate was recorded. After 12 weeks there was an average improvement of 96.2% with the infection in 80% nails completely resolved. "
Discussion
The next ePodiatry newsletter is online.
Link
Study to determine the efficacy of Clotrimazole 1% cream for the treatment of onychomycosis in association with the mechanical reduction of the nail plate
"Onychomycosis is invasion of the nail by dermatophytes yeasts and moulds [Calderon RA, Hay RJ. Fungicidal activity of human neutrophils and monocytes on dermatophyte fungi Tri. Quinckeanum and Tri. Rubrum. Immunology 1986;61:289–95; Degreef H. Onychomycosis. Br J Clin Pract Syn Suppl 1990;71:91–7; Zaias N. Clinical manifestations of onychomycosis. Clin Exp Dermatol 1992;17(1):6–7]. Causative organisms include T. rubrum and T. mentagrophytes. Fungi invade the distal and lateral under surfaces of the nail. The prevalence of onychomycosis approximates to 5–10% of the population and is increasing significantly in recent years [Stutz A. Allylamine derivatives—a new class of active substances in antifungal chemotherapy. Angew Chem 1987;2:320–8].Clotrimazole 1% cream is the most commonly prescribed topical antifungal agent in the United Kingdom although its use on nails has not been widely documented. Past inefficiencies may be due to the thickness of the nail plate. The mechanical reduction of the nail minimises the nail as a barrier to the absorption of the cream and increases the permeability of the nail plate.Subjects were ambulant and healthy with no systemic medication, no past history of anti-fungal agents and an ankle-brachial index indicating sufficient circulation for healing to occur. The infecting organism was identified by microscopy and culture. A total of ninety-two infected nails were isolated over a four-year period. The age range was 60–78 years. Nails were drilled every 14 days by the same operator and the area of infection mapped. Clotrimazole 1% cream was applied twice daily during the trial period and the percentage clearance rate was recorded. After 12 weeks there was an average improvement of 96.2% with the infection in 80% nails completely resolved. "
Discussion
The next ePodiatry newsletter is online.
Link
Tuesday, January 17, 2006
The next Podiatry Today
Full text articles are now available:
How To Resolve Conflict With Difficult Patients
Is External Fixation The Best Option For Calcaneal Fractures?
How To Resolve Conflict With Difficult Patients
Is External Fixation The Best Option For Calcaneal Fractures?
Saturday, January 14, 2006
Feds accuse foot doctor of massive Medi-fraud
This not good:
"Federal prosecutors say a Middlesex County podiatrist bilked the government of hundreds of thousands of Medicare dollars by submitting claims for treatments that were little more than massaging feet and clipping toenails. A civil complaint filed in federal court in Newark said Ming Tung, who lives in East Brunswick and has offices there and in Jersey City, ignored warnings about improper billings, instead filing more claims. Two years ago, authorities say, Tung received $856,000 in Medicare payments, or nearly 24 times the average reimbursement for a New Jersey foot doctor. Last year his filings topped $1.6 million. In many cases, Tung billed for visits to low-income apartment complexes in Middlesex and Hudson counties, where he allegedly gave foot massages in the lobbies. " Full story
"Federal prosecutors say a Middlesex County podiatrist bilked the government of hundreds of thousands of Medicare dollars by submitting claims for treatments that were little more than massaging feet and clipping toenails. A civil complaint filed in federal court in Newark said Ming Tung, who lives in East Brunswick and has offices there and in Jersey City, ignored warnings about improper billings, instead filing more claims. Two years ago, authorities say, Tung received $856,000 in Medicare payments, or nearly 24 times the average reimbursement for a New Jersey foot doctor. Last year his filings topped $1.6 million. In many cases, Tung billed for visits to low-income apartment complexes in Middlesex and Hudson counties, where he allegedly gave foot massages in the lobbies. " Full story
The Mid Tarsal Joint
The midtarsal joints is one of those joints that is subject to so much ongoing debate, discussion, scientifice and theroreticl modelling. Chris Nester has attempted to, at least, get everyone speaking the same language with this new publication: Clinical and Experimental Models of the Midtarsal Joint Proposed Terms of Reference and Associated Terminology Journal of the American Podiatric Medical AssociationVolume 96 Number 1 24-31 2006. Discussion here.
The next ePodiatry Newsletter is online.
The next ePodiatry Newsletter is online.
Friday, January 06, 2006
Happy New Year
The latest Podiatry Today has these fulll text articles available online:
Conquering Medial Tibial Stress Syndrome
Can Microcirculation Changes Predict Non-Healing Ulcers?
How To Address Nail Bed Injuries
Key Insights On Writing Orthotic Prescriptions
http://www.aboutus.org/Podiatry-Arena.com
Conquering Medial Tibial Stress Syndrome
Can Microcirculation Changes Predict Non-Healing Ulcers?
How To Address Nail Bed Injuries
Key Insights On Writing Orthotic Prescriptions
http://www.aboutus.org/Podiatry-Arena.com
Thursday, December 22, 2005
Comparison of foot orthoses made by podiatrists, pedorthists and orthotists
"Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p< .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and orthotists." More information and comments.
