Browsing by Person "Gibson, J. N. A."

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50+ Foot Challenges: Assessment and Evidence-Based Management
(Elsevier, 2009) Thomson, Colin E.; Gibson, J. N. A.
The new 50+ Foot Challenges: Assessment and Evidence-based management retains all the benefits of the popular first edition but adds more cases, more illustrations, new sections and invaluable appendices. The same illustrated case-history format as in the first edition presents readers with the clinical problems of each disorder. In each case, a problem-solving approach is encouraged through a question-and-answer format. This guides the reader to the appropriate diagnosis and treatment plan. Clinical tips for improving practice are included and each study concludes with a short list of key points and references to further reading. All those involved in the care and management of patients with foot conditions will find this book an invaluable aide-memoire and guide to their daily practice.
Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial
(American Orthopaedic Foot and Ankle Society, Inc., 2005) Gibson, J. N. A.; Thomson, Colin E.
Cost-effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial)
(2015-02) Edwards, Rhiannon Tudor; Yeo, Seow Tien; Russell, Daphne; Thomson, Colin E.; Beggs, Ian; Gibson, J. N. A.; McMillan, Diane; Martin, Denis J.; Russell, Ian T.
Background: Morton's neuroma is a common foot condition affecting health-related quality of life. Though its management frequently includes steroid injections, evidence of cost-effectiveness is sparse. So, we aimed to evaluate whether steroid injection is cost-effective in treating Morton's neuroma compared with anaesthetic injection alone. Methods: We undertook incremental cost-effectiveness and cost-utility analyses from the perspective of the National Health Service, alongside a patient-blinded pragmatic randomised trial in hospital-based orthopaedic outpatient clinics in Edinburgh, UK. Of the original randomised sample of 131 participants with Morton's neuroma (including 67 controls), economic analysis focused on 109 (including 55 controls). Both groups received injections guided by ultrasound. We estimated the incremental cost per point improvement in the area under the curve of the Foot Health Thermometer (FHT-AUC) until three months after injection. We also conducted cost-utility analyses using European Quality of life-5 Dimensions-3 Levels (EQ-5D-3L), enhanced by the Foot Health Thermometer (FHT), to estimate utility and thus quality-adjusted life years (QALYs). Results: The unit cost of an ultrasound-guided steroid injection was 149. Over the three months of follow-up, the mean cost of National Health Service resources was 280 for intervention participants and 202 for control participants - a difference of 79 [bootstrapped 95% confidence interval (CI): 18 to 152]. The corresponding estimated incremental cost-effectiveness ratio was 32 per point improvement in the FHT-AUC (bootstrapped 95% CI: 7 to 100). If decision makers value improvement of one point at 100 (the upper limit of this CI), there is 97.5% probability that steroid injection is cost-effective. As EQ-5D-3L seems unresponsive to changes in foot health, we based secondary cost-utility analysis on the FHT-enhanced EQ-5D. This estimated the corresponding incremental cost-effectiveness ratio as 6,400 per QALY. Over the recommended UK threshold, ranging from 20,000 to 30,000 per QALY, there is 80%-85% probability that steroid injection is cost-effective. Conclusions: Steroid injections are effective and cost-effective in relieving foot pain measured by the FHT for three months. However, cost-utility analysis was initially inconclusive because the EQ-5D-3L is less responsive than the FHT to changes in foot health. By using the FHT to enhance the EQ-5D, we inferred that injections yield good value in cost per QALY. Trial registration: Current Controlled Trials ISRCTN13668166. 2015 Edwards et al.; licensee BioMed Central.
Interventions for treating Morton's neuroma: a systematic review
(2004) Thomson, Colin E.; Martin, D. J.; Gibson, J. N. A.
Background Morton's neuroma is a common, paroxysmal neuralgia affecting the web spaces of the toes, typically the third. The pain is often so debilitating that patients become anxious about walking or even putting their foot to the ground. Insoles, corticosteroid injections, excision of the nerve, transposition of the nerve and neurolysis of the nerve are commonly used treatments. Their effectiveness is poorly understood. Objectives To examine the evidence from randomised controlled trials concerning the effectiveness of interventions in adults with Morton's neuroma. Search strategy We searched the Cochrane Neuromuscular Disease Group trials register (searched January 2003), MEDLINE (January 1966 to January Week 2 2003), EMBASE (January 1980 to February Week 2 2003), and CINAHL (January 1982 to February Week 1 2003). Selection criteria Randomised or quasi-randomised (methods of allocating participants to an intervention which were not strictly random e.g. date of birth, hospital record, number alternation) controlled trials of interventions for Morton's neuroma were selected. Studies where participants were not randomised into intervention groups were excluded. Data collection and analysis Two reviewers selected trials for inclusion in the review, assessed their methodological quality and extracted data independently. Main results Three trials involving 121 people were included. There is, at most, a very limited indication that transposition of the transected plantar digital nerve may yield better results than standard resection of the nerve in the long term. There is no evidence to support the use of supinatory insoles. There are, at best, very limited indications to suggest that dorsal incisions for resection of the plantar digital nerve may result in less symptomatic post-operative scars when compared to plantar excision of the nerve. Authors' conclusions There is insufficient evidence with which to assess the effectiveness of surgical and non-surgical interventions for Morton's neuroma. Well designed trials are needed to begin to establish an evidence base for the treatment of Morton's neuroma pain.