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Podiatry

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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.
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    A comparative investigation of the bacterial population of hot air hand dryers and paper towels
    (1994) Carline, Tom
    Our Research Report for 2000-2002 reflects an outstanding level of achievement throughout the institution and demonstrates once again our high level of commitment to strategic and applied research particularly in areas that enhance the quality of life.
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    A journey's end, and new roads beckoning
    (2008) Ellis, Mairghread JH
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    A Literature Review of Non-Surgical Intervention for the Treatment of Idiopathic Talipes Equinovarus: A Podiatric Perspective
    (FAOJ Editors, 2010-10) McGroggan, J.; Dunlop, G.
    This article aims to discuss the current surgical and non-surgical interventions in the treatment of idiopathic talipes equinovarus. It examines the literature from 1964 to the present day and includes a detailed anatomical description of the condition. The treatment of this condition has evolved from complicated surgical procedures with low long term success rates to less traumatic closed treatments with good outcomes. The latter, specifically the Ponseti Method of treatment, has been practiced by orthopaedic surgeons in the United Kingdom for seven years now and this article examines the podiatrist's potential role in the management of this lower limb complaint.
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    A model of ischemic pain in the calf and tens modification of lower limb pain: preliminary results.
    (2007) Roche, Patricia; Santos, Derek
    PURPOSE: To develop a model of laboratory induced ischemic calf pain; to test the analgesic efficacy of TENS for calf pain, and to describe induced calf pain, in healthy volunteers. RELEVANCE: We aimed to modify the sub maximum effort tourniquet technique (SMETT), a standardised method of inducing experimental ischemic pain into the upper limb of volunteers, to create a laboratory model of lower limb ischemia (LLI). With exercise, LLI could serve as a model of intermittent claudication (IC) - the exercise induced ischemic pain that is the main symptom of Peripheral Arterial Disease (PAD). Testing TENS for LLI pain could indicate its potential efficacy in IC related to PAD. PARTICIPANTS: 14 healthy males volunteered for Experiment 1 (E1) and 20 healthy females for Experiment 2 (E2). Subjects met inclusion and exclusion criteria for SMETT. METHODS: E1 was a within subject, crossover, single-blind study. A pilot study was undertaken with 4 independent subjects. The SMETT technique (with broad pressure cuff) was applied to the thigh. Subjects then performed 20 resisted plantar-flexion / dorsi-flexion exercises, using a pulley and weight apparatus developed for the study, in order to induce ischemia over a period of 5 minutes. Measurment of the Post Occlusive Reactive Hyperaemic response (PORHmax), demonstrated that ischemia had occurred in the calf of each subject, via the adapted SMETT technique. The main study in E1 applied (A) the standard SMETT in the upper limb and 20 minutes later (B) the modified SMETT (minus PORHmax) in the lower limb. Each application was for a maximum of 20 minutes. A linear pain scale rated subjective reports of pain intensity, at intervals between self-reported 'pain threshold' and 'pain tolerance'. The cuff was deflated at 'pain tolerance', or at 20 minutes, whichever came first. Subjects retrospectively described the ischemic pain in (i) the forearm and (ii) the calf, five minutes after cuff deflation. E2 utilised the E1 procedure for inducing lower limb ischemia and recording pain, to conduct an independent subject study of continuous TENS (100Hz, 200us) for induced LLI. Subjects were randomly allocated to a Control or TENS group. In the TENS group, electrodes were placed proximal and distal to the area of pain in the calf. ANALYSIS: Parametric or nonparametric tests examined differences between conditions; linear pain scales and weighted-rank MPQ - Pain Rating Index (PRI) scores For all statistical tests p-<-0.05. RESULTS: In E1, pain ratings at 300, 600, 900 12000 seconds showed similar incremental increases in pain intensity that are typical of SMETT induced ischemic pain, over time. In E2, TENS significantly raised the mean pain threshold and tolerance levels, and reduced MPQ-PRI scores, compared to controls (P-<-0.01 all comparisons). Qualitative MPQ descriptions reliably identified 4 sensory and 1 affective subclass of words to describe induced LLI pain. CONCLUSIONS: Lower limb ischemic pain induced with a modified SMETT can be modified by continuous TENS. IMPLICATIONS: A study into the efficacy of TENS during exercise in patients with PAD is indicated. Ref. 1. ROCHE PA et al.Physiotherapy Theory and Practice 2001, 18: 129-138 KEYWORDS: Pain; laboratory model, electrical stimulation. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: proche@qmuc.ac.uk
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    A modular device to measure the effects of plantar foot pressure on the microcirculation of the heel
    (Elsevier Science Ltd, 2003-03) Santos, Derek; Carline, Tom; Richmond, R.; Abboud, R.
    Background: Past research has concentrated on foot function and plantar foot pressure, with many devices developed for this purpose. However, little is known of how cutaneous blood flow compensates for ambulatory repetitive circulatory insults and how ulceration occurs. Objectives: To develop a system to measure the effects of plantar foot pressure on cutaneous blood flow in the supine and semi-weight bearing positions. Method: A system was developed that integrated a laser Doppler fluxmeter with a pressure probe, allowing plantar foot pressure and skin blood flow to be recorded simultaneously. The system was tested using four volunteers (288.6 years). Results: A significant difference existed between baseline laser Doppler flowmetry (LDF) in the supine and semi-weight bearing positions (P=0.023). Differences between both positions also existed in the reduction in LDF levels following application of pressure (P=0.015), the maximum hyperaemic response (P=0.034) and time taken to reach maximum hyperaemic response (P=0.019). Conclusion: The device has shown that with current technology it is now possible not only to investigate plantar foot pressure but also how it affects skin blood flow, which in some cases can lead to ulceration. The effect of plantar foot pressure on cutaneous blood flow differs depending on whether the subject is supine or semi-weight bearing. Thus, to understand the effects of plantar foot pressure on skin blood flow future researchers must ensure that subjects are in an upright position when recording.
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    A penicillin in-resistant Staphylococcus aureus infection
    (1993) Carline, Tom
    Paper adds to the growing body of evidence that children can acquire phonological systems before they are able to master the phonetic skills needed to convey the contrasts in that system
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    A pilot study to explore if the age that women undergo hallux valgus surgery influences the post-operative range of motion and level of satisfaction
    (2010) Milnes, Helen L.; Kilmartin, Timothy E.; Dunlop, G.
    Background Scarf and Akin osteotomies are commonly used to treat hallux valgus. One post-operative complication is a reduction in the range of motion at the first metatarsophalangeal joint. This can cause pain and restrict the heel height of footwear. This pilot study aims to examine if women's age has an effect on the post-operative outcome following Scarf and Akin osteotomies. Methods A pilot study using a convenience sample compared the outcomes of two groups of female patients, those aged under 50 and those aged over 50. The range of motion at the first metatarsophalangeal joint was measured using a goniometer, the American Orthopaedic Foot and Ankle Society (AOFAS) scale and satisfaction levels were collected 2 years post-operatively. Results There were no significant statistical differences between the two age groups for the outcomes measured. Similar AOFAS scores and ranges of motion were found for both age groups. Satisfaction levels were high but the under 50-year group were slightly less satisfied. Conclusions The outcome of this pilot study suggests that age does not have an effect on the range of motion of the first metatarsophalangeal joint, the AOFAS score or the level of patient satisfaction 2 years following Scarf and Akin osteotomies.
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    A Pseudomonas aeruginosa infection of the nail: a case report
    (1997) Santos, Derek; Carline, Tom; Weir, Evelyn C.
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    A review of the effects of external pressure on skin blood flow
    (Elsevier, 2003-12) Santos, Derek; Carline, Tom; Richmond, R.; Abboud, R.
    The human foot is a complex mechanical structure consisting of bones, ligaments and joints. They act together to provide a robust system capable of absorbing and dissipating the intermitted pressure that is subjected to its plantar surface during walking to prevent soft tissue breakdown. Current studies suggest that plantar foot pressure may lead to soft tissue breakdown (e.g. neuropathic ulceration) and hence research has so far concentrated on investigating the mechanical effects of plantar foot pressure on the foot's integrity. This has been possible through the widely available pressure and force platforms as well as in-shoe pressure systems. However, to understand how plantar foot pressure causes soft tissue breakdown it is vital to investigate both the physiological-mechanical interactions between the skin and plantar foot pressure. This review suggests that with the current advances in technology, the physiological response of skin blood flow to mechanical plantar foot pressure should be investigated and correlated further, both during static and dynamic loading, by developing a new system capable of either measuring both variables simultaneously or by synchronising two systems in real time.
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    A study to ascertain the potential inhalation hazard of toenail dust
    (The Society of Chiropodists and Podiatrists, 2003-02) Donaldson, C. L.; Carline, Tom; Brown, D. M.; Gilmour, P. S.; ELEGI Colt Laboratories; Donaldson, K.
    The use of the podiatric nail drill has become an acceptable way of reducing onychogryphotic nails in the clinical setting. The present study has demonstrated the presence of particles that are potentially dangerous to the human lung when they are contaminated with bacterial endotoxin (bacterial cell wall components that may cause an inflammatory response). Toenail dust collected from podiatric nail drills was examined for size, endotoxin content and the ability to stimulate release of IL-8 (IL- interleukins stimulate the release of other mediators in septic shock and inflammation) from macrophages and lung epithelial cells in vitro. The size distribution revealed a large number of particles that would deposit in the nose, airways and lung alveoli. Endotoxin was detected in extracts of nail particles and, interestingly, a component of these particles was able to stimulate substantial release of IL-8 from lung epithelial cells. Suspensions of toenail particles stimulated IL-8 release from monocyte-derived macrophages. Destruction of the endotoxin with the antibiotic polymyxin B still resulted in IL-8 release, suggesting that the particles themselves initiated the response and not necessarily the endotoxin. The authors conclude that podiatrists who routinely carry out nail reduction could be inhaling particles that could deposit throughout the respiratory tract, where they could contribute to inflammation by stimulating release of IL-8 from cells via the particles themselves and via endotoxin.
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    A survey of babywalkers in GP's, health visitors and orthopaedic surgeons
    (The Society of Chiropodists and Podiatrists, 1999) Cashley, D.; Carline, Tom
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    A systematic review of the sensitivity and specificity of the toe-brachial index for detecting peripheral artery disease
    (SAGE, 2016-05-10) Tehan, P. E.; Santos, Derek; Chuter, V. H.
    The toe-brachial index (TBI) is used as an adjunct to the ankle-brachial index (ABI) for non-invasive lower limb vascular screening. With increasing evidence suggesting limitations of the ABI for diagnosis of vascular complications, particularly in specific populations including diabetes cohorts, the TBI is being used more widely. The aim of this review was to determine the sensitivity and specificity of the TBI for detecting peripheral artery disease (PAD) in populations at risk of this disease. A database search was conducted to identify current work relating to the sensitivity and specificity of toe-brachial indices up to July 2015. Only studies using valid diagnostic imaging as a reference standard were included. The QUADAS-2 tool was used to critically appraise included articles. Seven studies met the inclusion criteria. Sensitivity of the TBI for PAD was reported in all seven studies and ranged from 45% to 100%; specificity was reported by five studies only and ranged from 16% to 100%. In conclusion, this review suggests that the TBI has variable diagnostic accuracy for the presence of PAD in specific populations at risk of developing the disease. There was a notable lack of large-scale diagnostic accuracy studies determining the diagnostic accuracy of the TBI in detecting PAD in different at-risk cohorts. However, standardised normal values need to be established for the TBI to conclusively determine the diagnostic accuracy of this test.
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    Accessing health information on the Internet
    (2012) Ellis, Mairghread JH
    With the advent of the Internet, health information has become more widely available, but questions remain over the appropriateness, accessibility, sheer volume, and quality of the materials. Here, the author provides some background on the health information-seeking behaviours of patients, and a discussion of how the healthcare professional can be an active and positive partner in the process.
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    Accidental intra-arterial injection -a cause of lower limb ischaemia in intravenous drug users
    (The Society of Chiropodists and Podiatrists, 1998) Weir, Evelyn C.; Carline, Tom