"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.
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Thursday, December 22, 2005
Saturday, December 17, 2005
What defines podiatry as a profession
In this discussion on Who Treats Feet?, I posted this message:
That is an issue - what defines "podiatry" as "podiatry" so that it is different from other professions --- in the USA, podiatry is clearly part of the medical model - in the rest of the world it is not, where it is a discipline similar to physiotherapy etc (that is despite limited numbers with surgical qualifications in places like the UK and Australia).
While it is one thing to aspire to the medical model, but is that feasible outside the USA where historical development and educational models are different? One train of thought I have been considering for a while, is just what is it that underpins the 'podiatric model'?
Take nursing as an eg....they used to be the doctors 'hand maidens' - the textbooks of >20 or so years ago reflected that. BUT, now there is no doubt about the very high levels of independence, professionalism and status of nurses as not being the doctors 'hand maidens'. What changed? What gave them this independence as a profession ..... take a look at the current and recent nursing (up to 10 or so years ago) textbooks - the change is obvious....its the concept of a 'nursing diagnosis' that has got nursing to where it is.
For example - the medical diagnosis might be 'chronic obstructive pulmonary disease'. The nursing diagnosis "is a clinical judgment about an individual, family or community response to actual and potential health problems/life processes" - is it will focus on restrictions in ADL's and how they can be facilitated etc. Look at attempts in the physiotherapy literature to define and develop a theoretical model/framework to define the "physiotherapy model'. Look at the plethora of recent textbooks from occupational therapy defining the occupational therpy model with models and frameworks --- they are very well developed and rapidly catching up to nursing in their ability to define their profession in such a way (no wonder they are no longer perceived as basket makers ).
Maybe its time we need to consider the concept of a 'podiatric diagnosis' that needs to be addressed in each patient to better define podiatry as a profession. Those who want to pursue the medical model will disagree with me here...For eg that corn on the fifth toe has a medical diagnosis of hyperkeratosis due to an adductovarus deformity of the fifth digit.... a podiatric diagnosis could be pain due to a pyschosocial problem that prevents them wearing appropriate footwear .... for which problem did the patient really come to us for? Which definition of this problem should we be directing our treatment at? The concept of a nursing diagnosis has defined 'nursing' and directs nursing interventions --- Do we need something similar?
What say you? Comments
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That is an issue - what defines "podiatry" as "podiatry" so that it is different from other professions --- in the USA, podiatry is clearly part of the medical model - in the rest of the world it is not, where it is a discipline similar to physiotherapy etc (that is despite limited numbers with surgical qualifications in places like the UK and Australia).
While it is one thing to aspire to the medical model, but is that feasible outside the USA where historical development and educational models are different? One train of thought I have been considering for a while, is just what is it that underpins the 'podiatric model'?
Take nursing as an eg....they used to be the doctors 'hand maidens' - the textbooks of >20 or so years ago reflected that. BUT, now there is no doubt about the very high levels of independence, professionalism and status of nurses as not being the doctors 'hand maidens'. What changed? What gave them this independence as a profession ..... take a look at the current and recent nursing (up to 10 or so years ago) textbooks - the change is obvious....its the concept of a 'nursing diagnosis' that has got nursing to where it is.
For example - the medical diagnosis might be 'chronic obstructive pulmonary disease'. The nursing diagnosis "is a clinical judgment about an individual, family or community response to actual and potential health problems/life processes" - is it will focus on restrictions in ADL's and how they can be facilitated etc. Look at attempts in the physiotherapy literature to define and develop a theoretical model/framework to define the "physiotherapy model'. Look at the plethora of recent textbooks from occupational therapy defining the occupational therpy model with models and frameworks --- they are very well developed and rapidly catching up to nursing in their ability to define their profession in such a way (no wonder they are no longer perceived as basket makers ).
Maybe its time we need to consider the concept of a 'podiatric diagnosis' that needs to be addressed in each patient to better define podiatry as a profession. Those who want to pursue the medical model will disagree with me here...For eg that corn on the fifth toe has a medical diagnosis of hyperkeratosis due to an adductovarus deformity of the fifth digit.... a podiatric diagnosis could be pain due to a pyschosocial problem that prevents them wearing appropriate footwear .... for which problem did the patient really come to us for? Which definition of this problem should we be directing our treatment at? The concept of a nursing diagnosis has defined 'nursing' and directs nursing interventions --- Do we need something similar?
What say you? Comments
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Friday, December 16, 2005
Plantar fasciitis discussions
Podiatry Arena has had a lot of good topics and discussions on plantar fasciitis:
Orthoses vs plantar fasciitis
Is a calcaneal spur in the plantar fascia?
Extracorporeal Shock Wave Therapy:
Ultrasound therapy for plantar fasciitis
Plantar fasciitis and dorsal pain
Nutrition and plantar fasciitis
Botulinum toxin and plantar fasciitis
First-Step Pain
Plantar fasciitis is associated with functional limitation in older people
Growth Factors For Chronic Plantar Fasciitis?
Wheatgrass cream no more effective than placebo for plantar fasciitis
Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy
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Orthoses vs plantar fasciitis
Is a calcaneal spur in the plantar fascia?
Extracorporeal Shock Wave Therapy:
Ultrasound therapy for plantar fasciitis
Plantar fasciitis and dorsal pain
Nutrition and plantar fasciitis
Botulinum toxin and plantar fasciitis
First-Step Pain
Plantar fasciitis is associated with functional limitation in older people
Growth Factors For Chronic Plantar Fasciitis?
Wheatgrass cream no more effective than placebo for plantar fasciitis
Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy
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Sunday, December 04, 2005
The common cold and cold feet.
The common cold is a viral infection .... being exposed to the cold does not cause a cold.... at least that is what I have always been led to believe - but is it so? This recent study has shown that cold symptoms develope in some when the feet are exposed to the cold:
Acute cooling of the feet and the onset of common cold symptoms.
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Acute cooling of the feet and the onset of common cold symptoms.
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Thursday, November 17, 2005
Does genu valgum cause the foot to pronate?
This one has troubled me for a while.
When teaching the pediatrics part of the course here, especially the genu varum and genu valgum, it always comes up about the effect they have on foot function. Genu vaurm affects the foot as it has to pronate to get the foot flat on the ground. According to so many podiatric texts, genu valgum also causes the foot to pronate as the center of body weight is medial to the subtalar joint -- this has always troubled me ... how can opposite alignments at the knee cause the same affect on foot function Is this just another one of those podiatric myths
As part of the lecture, I mention this troubling aspect --- sometimes, I get the students to do this exercise:
Stand up with feet wide apart (simulated genu valgum, due to wide base of gait) -what does your subtalar joint feel as though its doing? -- the answer is always "supinating" ---- so how does a genu valgum pronate a foot, like so many podiatric texts claim??
Now thanks to Bart Van Gheluwe we finally got some real data:
Effects of Simulated Genu Valgum and Genu Varum on Ground Reaction Forces and Subtalar Joint Function During GaitBart Van Gheluwe, Kevin A. Kirby and Friso Hagman
Journal of the American Podiatric Medical AssociationVolume 95 Number 6 531-541 2005
"The mechanical effects of genu valgum and varum deformities on the subtalar joint were investigated. First, a theoretical model of the forces within the foot and lower extremity during relaxed bipedal stance was developed predicting the rotational effect on the subtalar joint due to genu valgum and varum deformities. Second, a kinetic gait study was performed involving 15 subjects who walked with simulated genu valgum and genu varum over a force plate and a plantar pressure mat to determine the changes in the ground reaction force vector within the frontal plane and the changes in the center-of-pressure location on the plantar foot. These results predicted that a genu varum deformity would tend to cause a subtalar pronation moment to increase or a supination moment to decrease during the contact and propulsion phases of walking. With genu valgum, it was determined that during the contact phase a subtalar pronation moment would increase, whereas in the early propulsive phase, a subtalar supination moment would increase or a pronation moment would decrease. However, the current inability to track the spatial position of the subtalar joint axis makes it difficult to determine the absolute direction and magnitudes of the subtalar joint moments." (J Am Podiatr Med Assoc 95(6): 531–541, 2005)
What say you?
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When teaching the pediatrics part of the course here, especially the genu varum and genu valgum, it always comes up about the effect they have on foot function. Genu vaurm affects the foot as it has to pronate to get the foot flat on the ground. According to so many podiatric texts, genu valgum also causes the foot to pronate as the center of body weight is medial to the subtalar joint -- this has always troubled me ... how can opposite alignments at the knee cause the same affect on foot function Is this just another one of those podiatric myths
As part of the lecture, I mention this troubling aspect --- sometimes, I get the students to do this exercise:
Stand up with feet wide apart (simulated genu valgum, due to wide base of gait) -what does your subtalar joint feel as though its doing? -- the answer is always "supinating" ---- so how does a genu valgum pronate a foot, like so many podiatric texts claim??
Now thanks to Bart Van Gheluwe we finally got some real data:
Effects of Simulated Genu Valgum and Genu Varum on Ground Reaction Forces and Subtalar Joint Function During GaitBart Van Gheluwe, Kevin A. Kirby and Friso Hagman
Journal of the American Podiatric Medical AssociationVolume 95 Number 6 531-541 2005
"The mechanical effects of genu valgum and varum deformities on the subtalar joint were investigated. First, a theoretical model of the forces within the foot and lower extremity during relaxed bipedal stance was developed predicting the rotational effect on the subtalar joint due to genu valgum and varum deformities. Second, a kinetic gait study was performed involving 15 subjects who walked with simulated genu valgum and genu varum over a force plate and a plantar pressure mat to determine the changes in the ground reaction force vector within the frontal plane and the changes in the center-of-pressure location on the plantar foot. These results predicted that a genu varum deformity would tend to cause a subtalar pronation moment to increase or a supination moment to decrease during the contact and propulsion phases of walking. With genu valgum, it was determined that during the contact phase a subtalar pronation moment would increase, whereas in the early propulsive phase, a subtalar supination moment would increase or a pronation moment would decrease. However, the current inability to track the spatial position of the subtalar joint axis makes it difficult to determine the absolute direction and magnitudes of the subtalar joint moments." (J Am Podiatr Med Assoc 95(6): 531–541, 2005)
What say you?
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Sunday, October 02, 2005
Foot Outcomes measures
I let my frustration show a bit here:
Another bl....y outcome measure for the foot
"Does anyone share my frustration at the plethora of outcome tools that have been developed for the foot . When will it stop? When will people actually stop developing them and start doing research that actually uses them."
" It just seems as though people are more keen to develop yet another outcome tool, rather than spend that time using the ones we have. .... why waste resources reinventing the wheel? We should be getting on with doing research on, for eg, differences in outcomes between 2 interventions using outcome tools we now have, rather than develop new tools to measure the outcomes!!"
It followed the publication of yet another tool for measuring outcomes in the foot.
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Another bl....y outcome measure for the foot
"Does anyone share my frustration at the plethora of outcome tools that have been developed for the foot . When will it stop? When will people actually stop developing them and start doing research that actually uses them."
" It just seems as though people are more keen to develop yet another outcome tool, rather than spend that time using the ones we have. .... why waste resources reinventing the wheel? We should be getting on with doing research on, for eg, differences in outcomes between 2 interventions using outcome tools we now have, rather than develop new tools to measure the outcomes!!"
It followed the publication of yet another tool for measuring outcomes in the foot.
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Sunday, September 18, 2005
Good Feet Stores
There has been an exposure on this franchised chain of stores using hidden video camera's:
Good Feet Stores
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Good Feet Stores
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Mythbusting
Along the theme of the Discovery Channel's Mythbusters - Podiatry Arena has been doing some mythbusting:
The foot on the long side does not pronate more in LLD
Forefoot Varus is rare
"First Ray Hypermobility" is really bad terminology
Running shoe technology does not reduce injuries
Do foot orthoses weaken "arch" muscles?
Flat-footed 'are high achievers'
Is a calcaneal spur in the plantar fascia?
The myth & death of the hypermobile 1st ray
Good Feet Stores
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The foot on the long side does not pronate more in LLD
Forefoot Varus is rare
"First Ray Hypermobility" is really bad terminology
Running shoe technology does not reduce injuries
Do foot orthoses weaken "arch" muscles?
Flat-footed 'are high achievers'
Is a calcaneal spur in the plantar fascia?
The myth & death of the hypermobile 1st ray
Good Feet Stores
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Sunday, September 04, 2005
Lots of fun
Lots of fun and content at the Australasian Podiatry Council Conference in Christchurch, New Zealand. A couple of pictures and some reports here.
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Sunday, August 21, 2005
Foot pronation and leg length differences
I recently posted this message at Podiatry Arena
Asymmetrical foot pronation has the potential to create a LLD of up to 1cm (based on Bill Sanner's work), so obviously this will have consequences further up the chain (esp as the pronation is also associated with internal limb rotation).
What I am talking about is a foot pronately excessively as a compensation for a STRUCTURAL LLD - something that has crept into podiatric folklore over the years.... but its just another one of those myths (...'religious fanaticism' also comes to mind, but more on that later).I certainly do not see it clinically - I see feet pronate more on the long leg and I see feet pronate more on the short leg --- I just was not seeing the foot pronating with any increased frequency in the longer leg as I was taught and as I read frequently in the podiatric literature (...funny it does not appear in the orthopaedic or physiotherapy literature ). Invariably, when I did see a more pronated foot on the longer limb, its was often easy to find another reason for it (eg asymmetrical ankle joint ROM).
I used to get tired of students coming up to me in clinic when doing a gait analysis and saying things like "Craig, the left leg is longer, but I can't see it pronating more .... "maybe because it wasn't!!!" --- but thats what they got taught and read in the podiatric literature (they don't any more)
We did 3 studies:
1. Measured RCSP and navicular height between the short and long limb in those with a structural LLD --> there were no differences
2. A subsequent study used the FPI --> no differences
3. A Pedar in-shoe comparison --> there were some functional differences between the long and short limbs, but they were not related to any asymmetries in foot pronation.
As part of this, I also did an extensive literature review and it was not surprising that there was never any evidence to support this myth in the first place!!!!! (it is an interesting case study all this!!!!) ---- in fact the opposite was the case when viewing the literature!! (I will have to add the exact refs later when in office to get them).
The first was a study published quite some time ago that looked at 3D rearfoot kinematics and found no difference between the short and long limb in those with a structural LLD.
The other study is good case of .....(I better not say it ) --- it was published in JAPMA a long time ago, but the abstract, discussion and stated conclusion of this research was clear - that the foot does pronate more on the long side in those with a structural LLD .... BUT, BUT, BUT and very very very big BUT.... the paper looked at both functional and structural LLD and if you go thru the various tables in the publication (fortunately the paper listed the info on each subject) and extract just the data on those with a structural LLD (the tables mixed them all up) and then do a paired t-test (or wilcoxon) on the data, they actually showed the opposite!!! - ie there was no more pronated foot in the long or short limbs despite their claims ---> points to huge hole in peer review process prior to publication!!!
It just does not figure that the myth continues, when ALL the evidence says it does not happen.
We did try and publish our research, but you should have seen the reviewers comments from the journal --- they found nothing wrong with our methods and analysis etc, but spit a whole lot of vitriol with a recommendation to the editor that it not be published - the review was a two page rant paraphrased as "how dare they prove something wrong that every podiatrist knows is right".... they kept referring to all the evidence that supports the concept etc etc, but never mentioned what or where this evidence is. ..... I still have the manuscript (and the reviewers comments), but just have not yet bothered to rewrite it in a format for another journal yet.
The other amusing thing is, that a couple of years or so ago this topic came up in Barry Block's PM News (Kevin Kirby might remember this), so I posted a message re our research and the lack of evidence etc etc --- needless to say, it did not go down too well (at least I do remember Kevin supporting my observations) - I even got two private abusive emails saying something like "idiot" "moron" "how dare you" etc etc ---- guess which country and 3 letters after their names that these kinds of responses come from (I wish I kept them as it would be amusing to post them here now....) ..... 'religious fanaticisim' .....
....don't you just love this kind of stuff ?
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Asymmetrical foot pronation has the potential to create a LLD of up to 1cm (based on Bill Sanner's work), so obviously this will have consequences further up the chain (esp as the pronation is also associated with internal limb rotation).
What I am talking about is a foot pronately excessively as a compensation for a STRUCTURAL LLD - something that has crept into podiatric folklore over the years.... but its just another one of those myths (...'religious fanaticism' also comes to mind, but more on that later).I certainly do not see it clinically - I see feet pronate more on the long leg and I see feet pronate more on the short leg --- I just was not seeing the foot pronating with any increased frequency in the longer leg as I was taught and as I read frequently in the podiatric literature (...funny it does not appear in the orthopaedic or physiotherapy literature ). Invariably, when I did see a more pronated foot on the longer limb, its was often easy to find another reason for it (eg asymmetrical ankle joint ROM).
I used to get tired of students coming up to me in clinic when doing a gait analysis and saying things like "Craig, the left leg is longer, but I can't see it pronating more .... "maybe because it wasn't!!!" --- but thats what they got taught and read in the podiatric literature (they don't any more)
We did 3 studies:
1. Measured RCSP and navicular height between the short and long limb in those with a structural LLD --> there were no differences
2. A subsequent study used the FPI --> no differences
3. A Pedar in-shoe comparison --> there were some functional differences between the long and short limbs, but they were not related to any asymmetries in foot pronation.
As part of this, I also did an extensive literature review and it was not surprising that there was never any evidence to support this myth in the first place!!!!! (it is an interesting case study all this!!!!) ---- in fact the opposite was the case when viewing the literature!! (I will have to add the exact refs later when in office to get them).
The first was a study published quite some time ago that looked at 3D rearfoot kinematics and found no difference between the short and long limb in those with a structural LLD.
The other study is good case of .....(I better not say it ) --- it was published in JAPMA a long time ago, but the abstract, discussion and stated conclusion of this research was clear - that the foot does pronate more on the long side in those with a structural LLD .... BUT, BUT, BUT and very very very big BUT.... the paper looked at both functional and structural LLD and if you go thru the various tables in the publication (fortunately the paper listed the info on each subject) and extract just the data on those with a structural LLD (the tables mixed them all up) and then do a paired t-test (or wilcoxon) on the data, they actually showed the opposite!!! - ie there was no more pronated foot in the long or short limbs despite their claims ---> points to huge hole in peer review process prior to publication!!!
It just does not figure that the myth continues, when ALL the evidence says it does not happen.
We did try and publish our research, but you should have seen the reviewers comments from the journal --- they found nothing wrong with our methods and analysis etc, but spit a whole lot of vitriol with a recommendation to the editor that it not be published - the review was a two page rant paraphrased as "how dare they prove something wrong that every podiatrist knows is right".... they kept referring to all the evidence that supports the concept etc etc, but never mentioned what or where this evidence is. ..... I still have the manuscript (and the reviewers comments), but just have not yet bothered to rewrite it in a format for another journal yet.
The other amusing thing is, that a couple of years or so ago this topic came up in Barry Block's PM News (Kevin Kirby might remember this), so I posted a message re our research and the lack of evidence etc etc --- needless to say, it did not go down too well (at least I do remember Kevin supporting my observations) - I even got two private abusive emails saying something like "idiot" "moron" "how dare you" etc etc ---- guess which country and 3 letters after their names that these kinds of responses come from (I wish I kept them as it would be amusing to post them here now....) ..... 'religious fanaticisim' .....
....don't you just love this kind of stuff ?
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Saturday, August 13, 2005
The placebo effect of foot orthoses
We all know about the possible placebo effect of our treatments etc etc, but tend not to pay a great deal of attention to it...We have a plantar fasciitis RCT in press at the moment - subjects randomised to one of 3 "inserts" (all of which can be purchased from a retail pharmacy) - these are devices that I would never consider using clinically (they are that bad) ..... to our dismay all but 3 of the subjects got better - the world did not end then....Now just finished the number crunching on a second plantar fasciitis RCT. One group got the comfort model of Formthotics (not the regular one most use) and the other group got the same, but they were modified depending on the presence of risk factors for plantar fasciitis according to a strict protocol (ie tight calf muscles (lunge <38> heel raise; high force to establish windlass --> lateral column elevation; etc) --- we would have thought that this time we would find some differences .... but no - there was no difference between the two groups and everyone showed some symptomatic improvement ..... now you can see why I am in a "mood".At the end of the day, I just now think that when it comes to clinical trials with foot orthoses, that the placebo effect and Hawthorne effects are so powerful, everyone seems to get better .... this is forcing me to have a major rethink about how we really should be designing our foot orthoses clinical trials.
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Sunday, July 17, 2005
Is the calcaneal spur in the plantar fascia?
In a Yahoo Groups Discussion on manipulation, a question was asked:
"What is the best treatment for plantar fascitis induced heel spurs... " to which I replied:
"Since when did heel spurs have anything to do with the plantar fascia?"
Needless to say there was some interesting comments that followed, mostly based on what people were taught as students, and NOT on a reading of the research evidence.At the end of the day, all the published evidence I have seen, is that the spur is not in the plantar fasica, so how can plantar fasica "traction" cause heel spurs?One poster (Peter Morgan) did back up what I said with this:
"McCarthy DJ, Gorecki GE. The anatomical basis of inferior calcaneal lesions. JAPMA 1979;69:527This is quoted as finding the spur in the origin of the flexor digitorum brevis. ALSO, they asserted "the origin of flexor digitorum brevis, quad. plantae, long plantar ligament, abductor hallucis muscle and abductor digiti minumi are all sites of potential spur formation."
THIS WAS PUBLISHED IN 1979!!!! -- why do people still talk about the calcaneal heel spur as being due to traction of the plantar fascia. Now, I finally found one of the other more recent references showing the same thing:
"Heel Spur Formation and the Subcalcaneal Enthesis of the Plantar Fascia TSUKASA KUMAI and MIKE BENJAMIN Objective. To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia. Methods. The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs. Results. Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification. Conclusion. Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis. (J Rheumatol 2002;29:1957-64) "
That was 3 yrs ago. There are other references, I just don't have them handy. Is it not time to "put this one to bed"? What say you? Discussion
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"What is the best treatment for plantar fascitis induced heel spurs... " to which I replied:
"Since when did heel spurs have anything to do with the plantar fascia?"
Needless to say there was some interesting comments that followed, mostly based on what people were taught as students, and NOT on a reading of the research evidence.At the end of the day, all the published evidence I have seen, is that the spur is not in the plantar fasica, so how can plantar fasica "traction" cause heel spurs?One poster (Peter Morgan) did back up what I said with this:
"McCarthy DJ, Gorecki GE. The anatomical basis of inferior calcaneal lesions. JAPMA 1979;69:527This is quoted as finding the spur in the origin of the flexor digitorum brevis. ALSO, they asserted "the origin of flexor digitorum brevis, quad. plantae, long plantar ligament, abductor hallucis muscle and abductor digiti minumi are all sites of potential spur formation."
THIS WAS PUBLISHED IN 1979!!!! -- why do people still talk about the calcaneal heel spur as being due to traction of the plantar fascia. Now, I finally found one of the other more recent references showing the same thing:
"Heel Spur Formation and the Subcalcaneal Enthesis of the Plantar Fascia TSUKASA KUMAI and MIKE BENJAMIN Objective. To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia. Methods. The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs. Results. Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification. Conclusion. Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis. (J Rheumatol 2002;29:1957-64) "
That was 3 yrs ago. There are other references, I just don't have them handy. Is it not time to "put this one to bed"? What say you? Discussion
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Is the calcaneal spur in the plantar fascia?
In a Yahoo Groups Discussion on manipulation, a question was asked:
"What is the best treatment for plantar fascitis induced heel spurs... " to which I replied:
"Since when did heel spurs have anything to do with the plantar fascia?"
Needless to say there was some interesting comments that followed, mostly based on what people were taught as students, and NOT on a reading of the research evidence.At the end of the day, all the published evidence I have seen, is that the spur is not in the plantar fasica, so how can plantar fasica "traction" cause heel spurs?One poster (Peter Morgan) did back up what I said with this:
"McCarthy DJ, Gorecki GE. The anatomical basis of inferior calcaneal lesions. JAPMA 1979;69:527This is quoted as finding the spur in the origin of the flexor digitorum brevis. ALSO, they asserted "the origin of flexor digitorum brevis, quad. plantae, long plantar ligament, abductor hallucis muscle and abductor digiti minumi are all sites of potential spur formation."
THIS WAS PUBLISHED IN 1979!!!! -- why do people still talk about the calcaneal heel spur as being due to traction of the plantar fascia. Now, I finally found one of the other more recent references showing the same thing:
"Heel Spur Formation and the Subcalcaneal Enthesis of the Plantar Fascia TSUKASA KUMAI and MIKE BENJAMIN Objective. To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia. Methods. The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs. Results. Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification. Conclusion. Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis. (J Rheumatol 2002;29:1957-64) "
That was 3 yrs ago. There are other references, I just don't have them handy. Is it not time to "put this one to bed"? What say you? Discussion
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"What is the best treatment for plantar fascitis induced heel spurs... " to which I replied:
"Since when did heel spurs have anything to do with the plantar fascia?"
Needless to say there was some interesting comments that followed, mostly based on what people were taught as students, and NOT on a reading of the research evidence.At the end of the day, all the published evidence I have seen, is that the spur is not in the plantar fasica, so how can plantar fasica "traction" cause heel spurs?One poster (Peter Morgan) did back up what I said with this:
"McCarthy DJ, Gorecki GE. The anatomical basis of inferior calcaneal lesions. JAPMA 1979;69:527This is quoted as finding the spur in the origin of the flexor digitorum brevis. ALSO, they asserted "the origin of flexor digitorum brevis, quad. plantae, long plantar ligament, abductor hallucis muscle and abductor digiti minumi are all sites of potential spur formation."
THIS WAS PUBLISHED IN 1979!!!! -- why do people still talk about the calcaneal heel spur as being due to traction of the plantar fascia. Now, I finally found one of the other more recent references showing the same thing:
"Heel Spur Formation and the Subcalcaneal Enthesis of the Plantar Fascia TSUKASA KUMAI and MIKE BENJAMIN Objective. To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia. Methods. The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs. Results. Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification. Conclusion. Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis. (J Rheumatol 2002;29:1957-64) "
That was 3 yrs ago. There are other references, I just don't have them handy. Is it not time to "put this one to bed"? What say you? Discussion
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Sunday, May 29, 2005
Foot Health Status Measures
There are a number of tools for measuring outcomes and foot health status. Some of the tools include, the Foot Health Status Questionnaire, the Foot Function Index and now there is the Bristol Foot Score
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Foot Health Status Measures
There are a number of tools for measuring outcomes and foot health status. Some of the tools include, the Foot Health Status Questionnaire, the Foot Function Index and now there is the Bristol Foot Score
Back to home page
Back to home page
Wednesday, May 25, 2005
Podiatrist gets death penalty
From LA Times
A federal jury decided that a Chicago podiatrist should get the death penalty for killing a disabled patient to keep her from testifying against him in a Medicare fraud case. Ronald Mikos, 56, was convicted earlier this month of murder, and was also found guilty of defrauding Medicare out of more than $1 million by billing it for thousands of operations that he never performed. Mikos shot Joyce Brannon six times in the neck and head days before she was scheduled to tell a federal grand jury about how he claimed to have performed numerous operations on her that never took place. Her grand jury subpoena was found near her body in her apartment.
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A federal jury decided that a Chicago podiatrist should get the death penalty for killing a disabled patient to keep her from testifying against him in a Medicare fraud case. Ronald Mikos, 56, was convicted earlier this month of murder, and was also found guilty of defrauding Medicare out of more than $1 million by billing it for thousands of operations that he never performed. Mikos shot Joyce Brannon six times in the neck and head days before she was scheduled to tell a federal grand jury about how he claimed to have performed numerous operations on her that never took place. Her grand jury subpoena was found near her body in her apartment.
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Podiatrist gets death penalty
From LA Times
A federal jury decided that a Chicago podiatrist should get the death penalty for killing a disabled patient to keep her from testifying against him in a Medicare fraud case. Ronald Mikos, 56, was convicted earlier this month of murder, and was also found guilty of defrauding Medicare out of more than $1 million by billing it for thousands of operations that he never performed. Mikos shot Joyce Brannon six times in the neck and head days before she was scheduled to tell a federal grand jury about how he claimed to have performed numerous operations on her that never took place. Her grand jury subpoena was found near her body in her apartment.
Back to home page
A federal jury decided that a Chicago podiatrist should get the death penalty for killing a disabled patient to keep her from testifying against him in a Medicare fraud case. Ronald Mikos, 56, was convicted earlier this month of murder, and was also found guilty of defrauding Medicare out of more than $1 million by billing it for thousands of operations that he never performed. Mikos shot Joyce Brannon six times in the neck and head days before she was scheduled to tell a federal grand jury about how he claimed to have performed numerous operations on her that never took place. Her grand jury subpoena was found near her body in her apartment.
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Sunday, May 15, 2005
Podiatrist facing death penalty.
This has been an interesting story to follow:
"A Chicago podiatrist murdered a former patient just days before she was to testify against him in a fraud probe because the doctor believed she would be the lone witness against him, a prosecutor said Tuesday..."
"Joyce Brannon had reportedly undergone 72 foot surgeries at the hands of Chicago podiatrist Ronald Mikos, the man she was set to testify against in a 2002 Medicare fraud case..."
"A federal jury quickly convicted a Chicago podiatrist Thursday on all 25 counts against him, including murdering a disabled patient to silence her.... " Link
"A defense attorney today pleaded for the life of a Chicago podiatrist convicted of killing a handicapped woman who planned to testify against him in a Medicare fraud case...." Link
"A woman who had two children with a Chicago podiatrist facing a possible sentence of death testified Wednesday that the children would be devastated if their father was executed...."
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"A Chicago podiatrist murdered a former patient just days before she was to testify against him in a fraud probe because the doctor believed she would be the lone witness against him, a prosecutor said Tuesday..."
"Joyce Brannon had reportedly undergone 72 foot surgeries at the hands of Chicago podiatrist Ronald Mikos, the man she was set to testify against in a 2002 Medicare fraud case..."
"A federal jury quickly convicted a Chicago podiatrist Thursday on all 25 counts against him, including murdering a disabled patient to silence her.... " Link
"A defense attorney today pleaded for the life of a Chicago podiatrist convicted of killing a handicapped woman who planned to testify against him in a Medicare fraud case...." Link
"A woman who had two children with a Chicago podiatrist facing a possible sentence of death testified Wednesday that the children would be devastated if their father was executed...."
Back to home
Podiatrist facing death penalty.
This has been an interesting story to follow:
"A Chicago podiatrist murdered a former patient just days before she was to testify against him in a fraud probe because the doctor believed she would be the lone witness against him, a prosecutor said Tuesday..."
"Joyce Brannon had reportedly undergone 72 foot surgeries at the hands of Chicago podiatrist Ronald Mikos, the man she was set to testify against in a 2002 Medicare fraud case..."
"A federal jury quickly convicted a Chicago podiatrist Thursday on all 25 counts against him, including murdering a disabled patient to silence her.... " Link
"A defense attorney today pleaded for the life of a Chicago podiatrist convicted of killing a handicapped woman who planned to testify against him in a Medicare fraud case...." Link
"A woman who had two children with a Chicago podiatrist facing a possible sentence of death testified Wednesday that the children would be devastated if their father was executed...."
Back to home
"A Chicago podiatrist murdered a former patient just days before she was to testify against him in a fraud probe because the doctor believed she would be the lone witness against him, a prosecutor said Tuesday..."
"Joyce Brannon had reportedly undergone 72 foot surgeries at the hands of Chicago podiatrist Ronald Mikos, the man she was set to testify against in a 2002 Medicare fraud case..."
"A federal jury quickly convicted a Chicago podiatrist Thursday on all 25 counts against him, including murdering a disabled patient to silence her.... " Link
"A defense attorney today pleaded for the life of a Chicago podiatrist convicted of killing a handicapped woman who planned to testify against him in a Medicare fraud case...." Link
"A woman who had two children with a Chicago podiatrist facing a possible sentence of death testified Wednesday that the children would be devastated if their father was executed...."
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Sunday, May 08, 2005
Custom vs prefabricated fot orthoses
This debate has been going on for years and will continue. All research to date has shown no differences in outcomes between the two. The exception is this recent publication on foot pain in those with juvenile chronic athritis:
Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and ILONA S. SZER
Objective. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
(J Rheumatol 2005;32:943-50)
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Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and ILONA S. SZER
Objective. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
(J Rheumatol 2005;32:943-50)
Back to home page
Custom vs prefabricated fot orthoses
This debate has been going on for years and will continue. All research to date has shown no differences in outcomes between the two. The exception is this recent publication on foot pain in those with juvenile chronic athritis:
Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and ILONA S. SZER
Objective. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
(J Rheumatol 2005;32:943-50)
Back to home page
Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and ILONA S. SZER
Objective. To compare the clinical efficacy of custom foot orthotics, prefabricated "off-the-shelf" shoe inserts, and supportive athletic shoes worn alone, on reducing pain and improving function for children with juvenile idiopathic arthritis (JIA).
Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup.
Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures.
Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone.
(J Rheumatol 2005;32:943-50)
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Sunday, May 01, 2005
Nurses providing footcare
Nurses providing foot care is proving to be somewhat controversial:
Nurses Administering FootHealthCare in UK?
Nurses Entrepreneurial Foot Care Association of Canada
The New Foot Care Nurse... COMMENTS!
Add your comments...
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Nurses Administering FootHealthCare in UK?
Nurses Entrepreneurial Foot Care Association of Canada
The New Foot Care Nurse... COMMENTS!
Add your comments...
Back to home page
Nurses providing footcare
Nurses providing foot care is proving to be somewhat controversial:
Nurses Administering FootHealthCare in UK?
Nurses Entrepreneurial Foot Care Association of Canada
The New Foot Care Nurse... COMMENTS!
Add your comments...
Back to home page
Nurses Administering FootHealthCare in UK?
Nurses Entrepreneurial Foot Care Association of Canada
The New Foot Care Nurse... COMMENTS!
Add your comments...
Back to home page
Friday, March 25, 2005
Cancer Metatasis to the Foot
Every few years, there is a case report in the literature of foot pain being either the presenting feature of cancer or occuring in those with known cancer somewhere else in the body (due to a metastasis). Recently, there have been two ..... providing a timely reminder of our importance in arriving at a correct diagnosis:
From: International Urology & Nephrology. 2004;36(3):329-30.
Renal cell carcinoma presenting as solitary foot metastasis. [quote]Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.
From: Onkologie. 2005 Mar;28(3):141-3
Isolated talus metastasis from breast carcinoma: a case report and review of the literature. [quote]Background: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. Case Report: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. Results: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. Conclusion: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
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From: International Urology & Nephrology. 2004;36(3):329-30.
Renal cell carcinoma presenting as solitary foot metastasis. [quote]Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.
From: Onkologie. 2005 Mar;28(3):141-3
Isolated talus metastasis from breast carcinoma: a case report and review of the literature. [quote]Background: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. Case Report: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. Results: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. Conclusion: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
Back to home page
Cancer Metatasis to the Foot
Every few years, there is a case report in the literature of foot pain being either the presenting feature of cancer or occuring in those with known cancer somewhere else in the body (due to a metastasis). Recently, there have been two ..... providing a timely reminder of our importance in arriving at a correct diagnosis:
From: International Urology & Nephrology. 2004;36(3):329-30.
Renal cell carcinoma presenting as solitary foot metastasis. [quote]Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.
From: Onkologie. 2005 Mar;28(3):141-3
Isolated talus metastasis from breast carcinoma: a case report and review of the literature. [quote]Background: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. Case Report: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. Results: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. Conclusion: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
Back to home page
From: International Urology & Nephrology. 2004;36(3):329-30.
Renal cell carcinoma presenting as solitary foot metastasis. [quote]Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.
From: Onkologie. 2005 Mar;28(3):141-3
Isolated talus metastasis from breast carcinoma: a case report and review of the literature. [quote]Background: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. Case Report: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. Results: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. Conclusion: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
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Monday, March 14, 2005
Qualitative research on diabetic foot ulcers
Medscape have a full text article on this (free registration required to access)
A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
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A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
Back to home page
Qualitative research on diabetic foot ulcers
Medscape have a full text article on this (free registration required to access)
A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
Back to home page
A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
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Sunday, February 27, 2005
New research should have impact on clinical practice
The latest Diabetes Care has two important papers:
Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
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Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
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New research should have impact on clinical practice
The latest Diabetes Care has two important papers:
Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
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Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
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Sunday, February 06, 2005
RCT on Foot orthoses and low back pain
A Controlled Randomized Study of the Effect of Training With Orthoses on the Incidence of Weight Bearing Induced Back Pain Among Infantry Recruits. Spine. 2005 Feb 1;30(3):272-275.Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A.
Quote:
STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
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Quote:
STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
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RCT on Foot orthoses and low back pain
A Controlled Randomized Study of the Effect of Training With Orthoses on the Incidence of Weight Bearing Induced Back Pain Among Infantry Recruits. Spine. 2005 Feb 1;30(3):272-275.Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A.
Quote:
STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
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Quote:
STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
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Friday, January 28, 2005
Ischemic diabetic foot ulcers do respond to total contact casting
There has always been a reluctance to use total contact cats on diabetic ischemic ulcers. This latest study in Diabetes Care has shown that moderate ischaemic ulcers do respond:
Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
OBJECTIVE— A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.
RESEARCH DESIGN AND METHODS— Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.
RESULTS— Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P CONCLUSIONS— In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.
Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC
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Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
OBJECTIVE— A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.
RESEARCH DESIGN AND METHODS— Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.
RESULTS— Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P CONCLUSIONS— In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.
Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC
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Ischemic diabetic foot ulcers do respond to total contact casting
There has always been a reluctance to use total contact cats on diabetic ischemic ulcers. This latest study in Diabetes Care has shown that moderate ischaemic ulcers do respond:
Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
OBJECTIVE— A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.
RESEARCH DESIGN AND METHODS— Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.
RESULTS— Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P CONCLUSIONS— In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.
Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC
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Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
OBJECTIVE— A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.
RESEARCH DESIGN AND METHODS— Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.
RESULTS— Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P CONCLUSIONS— In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.
Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC
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Friday, January 21, 2005
Interclinician variation in diabetes foot assessment- a national lottery?
From the latest Diabetic Medicine:
Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses
Discussion here.
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Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses
Discussion here.
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Interclinician variation in diabetes foot assessment- a national lottery?
From the latest Diabetic Medicine:
Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses
Discussion here.
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Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses
Discussion here.
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