Saturday, July 25, 2009

Laser treatment for toenail fungus

This is an interesting one to blog about, but has everything to do with innovation and bringing products to the market. The laser treatment for toenail fungus (onychomycosis) is a recent innovation. The clinical trials by the company, PinPointe, are underway and no results are yet available. However, many clinics are beginning to widely use and tout this treatment. All the evidence for it is the testimonials and unsubstantiated claims. There are many clips on You Tube about it. Its not cheap and costs a lot of money. My interest in this was piqued when this marketing of a product before the evidence comes in as to its efficacy is lacking. This is a pattern that has been repeated many times in the history of the profession. More often than not, the use of the product dies off as the evidence come in. Don’t we ever learn by our mistakes?

(See this on Podiatry Arena: Nail fungus laser treatment; Laser treatment for nail fungus)

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The MOSI Foot Orthotics

If the foot is abnormally pronating and causing problems, there is only one way it can be stopped. It has to be stopped by the use of a force on the medial side of the assumed subtalar joint axis. While this makes intuitive sense, the problem arises as the position of the axis varies substantially. There are clinical tests that can tell us where the axis is, so we can work out where the force from a foot orthoses has to be applied.

When the axis is located more medially located, the problem comes that there is very little room on the plantar surface medial to the joint axis for that force to be applied. To apply the force various orthotic design parameters have been developed. There is the DC Wedge, Kirby medial skive, the the Blake Inverted foot orthotic.

Recently a unique design, the MOSI foot orthotic has been proposed by Paul Harradine, and Simon Collins., Chris Webb , Lawrence Bevan. The MOSI orthotic stands for medial oblique shell inclination. The aim of this design is to incline upwards the shell of the orthotic on the medial side of the subtalar joint axis. It is an interesting innovative design that makes good theoretical sense.

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