Podiatry
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7
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Item 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.Item Hemiarthroplasty augmented with bone graft for the failed hallux metatarsophalangeal Silastic implant(Elsevier, 2011-09) Anakwe, R. E.; Middleton, S. D.; Thomson, Colin E.; McKinley, J. C.Symptomatic failure of Silastic1 implants at the hallux metatarsophalangeal joint can result in the challenging problem of instability which may be painful. There is often marked bone loss making reconstruction difficult. Arthrodesis sacrifices joint movement while excision arthroplasty shortens the ray and is less acceptable to active patients. We describe a case in which reconstruction was achieved by using a porous coated metatarsophalangeal hemiarthroplasty augmented with bone graft with good early results. This previously unreported technique may offer an additional surgical option for reconstruction, maintaining joint movement without compromising future arthrodesis or excision arthroplasty as salvage measures. Long term follow up is required to confirm the success of this technique.Item 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.Item Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial.(2013-05) Thomson, Colin E.; Beggs, I.; Martin, D. G.; McMillan, D.; Edwards, R. T.; Russell, D.; Yeo, S. T.; Russell, I. T.; Gibson, J. N.Morton neuroma is a common cause of neuralgia affecting the web spaces of the toes. Corticosteroid injections are commonly administered as a first-line therapy, but the evidence for their effectiveness is weak. Our primary research aim was to determine whether corticosteroid injection is an effective treatment for Morton neuroma compared with an anesthetic injection as a placebo control. We performed a pragmatic, patient-blinded randomized trial set within hospital orthopaedic outpatient clinics in Edinburgh, United Kingdom. One hundred and thirty-one participants with Morton neuroma (mean age, fifty-three years; 111 [85%] female) were randomized to receive either corticosteroid and anesthetic (1 mL methylprednisolone [40 mg] and 1 mL 2% lignocaine) or anesthetic alone (2 mL 1% lignocaine). An ultrasonographic image was obtained before treatment, and injections were performed with the needle placed under ultrasonographic guidance. The primary outcome was the difference in patient global assessment of foot health between the two groups at three months after injection. This was measured with use of a 100-unit visual analog scale (VAS) anchored by best imaginable health state and worst imaginable health state. Compared with the control group, global assessment of foot health in the corticosteroid group was significantly better at three months (mean difference, 14.1 scale points [95% confidence interval, 5.5 to 22.8 points]; p = 0.002). The difference between the groups was also significant at one month. Significant and nonsignificant improvements associated with the corticosteroid injection were observed for measures of pain, function, and patient global assessment of general health at one and three months after injection. The size of the neuroma as determined by ultrasonography did not significantly influence the treatment effect. Corticosteroid injections for Morton neuroma can be of symptomatic benefit for at least three months.Item Consumer health information on the WWW: An evaluation of information on verrucae(2003-07-19) Ellis, Mairghread JH; Thomson, Colin E.Background: Increasingly the World Wide Web (WWW) is used as a first source by individuals seeking health information, and it is actively promoted as an information source by the NHS. Objective: This study evaluated the accessibility and quality of WWW-based information about verrucae, a condition where podiatrists often encourage self-treatment. Method: Using the term verruca- a variety of searches were undertaken. Outcome measures- - quality scores for information according to developed criteria; - presence of the Health on the Net Foundation (HONcode logo), to indicate quality of website. Results: Twenty-three sites were evaluated. Overall, quality of information was low, due to lack of information, rather than inaccuracy. Consumer health websites returned the highest mean scores for information quality. Sites of academic/professional and commercial ownership contained a higher quality of information than privately owned, or NHS-owned. Three sites (13%) displayed the Health on the Net Foundation logo, indicating adherence to their ethical standards. Conclusions: Results suggest that while relevant information is available on the WWW, it is not always easy to locate. It is essential to use appropriate search terms, and to appraise every site. Healthcare practitioners may have a role to play in guiding consumers towards effective search strategies, thus ensuring safe, relevant information is accessed.Item 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.Item The effectiveness of extra corporeal shock wave therapy for plantar heel pain : a systematic review and meta-analysis(BioMed Central, 2005-04-22) Thomson, Colin E.; Crawford, Fay; Murray, GordonBackground There is considerable controversy regarding the effectiveness of extracorporeal shock wave therapy in the management of plantar heel pain. Our aim was to conduct a systematic review of randomised controlled trials to investigate the effectiveness of extracorporeal shock wave therapy and to produce a precise estimate of the likely benefits of this therapy. Methods We conducted a systematic review of all randomised controlled trials (RCTs) identified from the Cochrane Controlled trials register, MEDLINE, EMBASE and CINAHL from 1966 until September 2004. We included randomised trials which evaluated extracorporeal shock wave therapy used to treat plantar heel pain. Trials comparing extra corporeal shock wave therapy with placebo or different doses of extra corporeal shock wave therapy were considered for inclusion in the review. We independently applied the inclusion and exclusion criteria to each identified randomised controlled trial, extracted data and assessed the methodological quality of each trial. Results Six RCTs (n = 897) permitted a pooled estimate of effectiveness based on pain scores collected using 10 cm visual analogue scales for morning pain. The estimated weighted mean difference was 0.42 (95% confidence interval 0.02 to 0.83) representing less than 0.5 cm on a visual analogue scale. There was no evidence of heterogeneity and a fixed effects model was used. Conclusion A meta-analysis of data from six randomised-controlled trials that included a total of 897 patients was statistically significant in favour of extracorporeal shock wave therapy for the treatment of plantar heel pain but the effect size was very small. A sensitivity analysis including only high quality trials did not detect a statistically significant effect.