Podiatry Review (Q2) Spring 2018

The Institute of Chiropodists and Podiatrists News

A

Editor: Abid Ali, CFPodM, BSc, MInstChP

Academic Editor: Martin Harvey, PGCert, BSc, MInstChP, MCPodS

Academic Advisor: David M Holland, MSc(Dunelm), MFPM - RCPS(Glasg).

Academic Review Team

Ms B Wright, MSc BSc (Hons), PGCE PGDip, FInstChP

Mr S Miah, CFPodM, MInstChP

Mr A Ali, CFPodM, BSc, MInstChP

Media and Publicity Contact: Martin Harvey, PGCert, BSc, MInstChP, MCPodS

Email: media@iocp.org.uk

Medicines and Procedures Panel (MaPP)

Chair: Andrew Williams, MInstChP, CFPodM

Abid Ali, CFPodM, BSc, MInstChP

Somuz Miah, CFPodM, MInstChP

Martin Harvey, PGCert, BSc, MInstChP, MCPodS

IOCP Contacts

Executive Committee

President: Mrs L Pearson, FInstChP, BSc Pod Med

Chair Executive Committee: Mr M Harvey, PGCert, BSc, MInstChP, MCPodS

Chair Board of Education: Mr A Ali, CFPodM, BSc, MInstChP

Vice-Chair Board of Education: Ms B Wright, MSc BSc (Hons), PGCE PGDip, FInstChP

Honorary Treasurer: Mr S Miah, CFPodM, BSc (PodM), MInstChP Company Secretary: Miss A J Burnett-Hurst, HonFInstChP Standing Orders Committee: Mr M Franklin, MInstChP

Midland Area Council: Mr S Miah, CFPodM, BSc (PodM), MInstChP

North West Area Council: Mr D Topping, MInstChP

Irish Area Council: TBC

Scottish Area Council: Mrs H Jephcote, MInstChP

Southern Area Council: TBC

Yorkshire Area Council: Mrs M Ward, MInstChP

Branch Secretary Contacts

Branch Secretary Telephone Email

Birmingham & the Shires Kate Harrison 01789 262365 kathrynharrison87@gmail.com

Cheshire & North Wales Michelle Taylor 01704 540614 michelle.taylor35@hotmail.co.uk

Devon and Cornwall Mark Smith 01803 520788 mrkjoanne@aol.co.uk

Essex Beverley Wright 01702 460890 solespirits@hotmail.com

Leeds Caroline McCartney 07583 934468 hello@chiropodybycaroline.co.uk

Leicester & Northants Barbara Bletsoe 07790 350109 bbletsoe@hotmail.co.uk

London Sarah Bowen 07790 717833 footwoman@gmail.com

North West Alison Marsden 01772 623180 alison.marsden@hotmail.com

Northern Ireland Paula McDonnell 028 9062 7414 paulapod@hotmail.co.uk

Nottingham Valerie Dunsworth 0115 931 3492 adunsworth@btinternet.com

Republic of Ireland Breda Murphy 00353 868 525842 secretary.iocp@outlook.com

Sheffield Helen Rawse 07789 025022 hrawse@live.co.uk

South Wales & Monmouth Esther Danahar 01656 740772 estherdanahar@yahoo.co.uk

Sussex Linda Parks 01323 646611 lindaparks1955@hotmail.co.uk

Teesside

Jon Ollivier 01287 349517 jon.ollivier@gmail.com

Western Dawn Hinton 07908 441781 dawnhinton77@gmail.com

West of Scotland John Stott 0780 135 6585 jls@stottland.com

Wolverhampton Lynn Newland 07824 395487 lynnfeet@msn.com

Dear Reader

Welcome to the Spring issue of Podiatry Review.

As this year rapidly passes by and the HCPC audit looms, it is good to check that your CPD is in order. If not, don’t worry as there’s an abundance of opportunities for you to catch up.

I have recently attended a Safeguarding Children and Adults course which has given me a greater insight into the warning signs to look for and what would be the next best direction to steer that individual in, if and when necessary, definitely worth while for all Practitioners and anyone who comes into contact with the general public.

Ivan Bristow has an update for a new innovative test strip kit for the diagnosis of fungal nails, which is quick and easy for the practitioner to use and is an effective aide for diagnosis.

There is also a really good article by Iain McIntosh on systemic arthritis, an excellent source of revision.

Forensic Science has always fascinated me, maybe it was watching all those episodes of Quincy M.E., so the article by Barrister Catherine Brown on Forensic Podiatry is really worth a read (Pages 6 & 7).

It is with great sadness that our colleague Jenny (Linda) Reid from Western Branch lost her long battle with cancer, she will be missed by all who knew her and for her tireless charity work.

Dates for your diary, the IOCP will have a visible presence at Naidex, COPA and Primary Care (see adverts for more info) so if you’re attending, come over and see us! 11th & 12th May IOCP National Podiatry Conference. May is also National walking month and Skin Cancer Awareness month, in addition it is World Foot Health month and 11th-17th June brings Diabetes awareness week.

I look forward to seeing you at this years National Podiatry Conference, which will be the final year at Southport in its present format, so come along and celebrate the best Social, Educational and Networking event of this year!

Keep us informed of your local Branch meetings and Seminars, I recently attended the Leeds seminar, which was a great informative and networking day.

Happy reading!

Kind regards,

Linda Pearson President

Guidelines for new and established authors

Content of your article should be Podiatry or foot health-related. Podiatry Review is mostly in easy-to-read format, and articles for submission should reflect this.

Please ensure that your name and title (ie - FHP, Podiatrist, or other) are included with your article.

Please proof-read and spell-check your article before submission.

It would be helpful to the Editorial Committee if you could reference any books or Papers mentioned in your article. If you are not sure how to do this we are happy to assist.

Presenting expert witness evidence in Court…

Top tips for Chiropodists and Podiatrists

Chiropodists and Podiatrists who act as expert witnesses may find themselves in a court giving evidence. The witness box is a lonely place and experts can feel they’re on trial, standing in the dock rather than giving independent testimony to assist the court. Doubt may be cast on their experience, notes, method of investigation and the procedures. Nevertheless, as an expert you must have the ability to competently and confidently present your findings and recommendations at court.

Yet with some thoughts it is possible to make the experience of giving evidence easier.

What are the main things to remember?

Be well prepared: You should make sure you know where the court is, arrive to on time and should dress well. You must be fully prepared and should know your expert witness report thoroughly so that you are not caught off guard. It is helpful to consider in advance where challenges in your evidence may arise.

Direct answers to the decision-maker: You need to appreciate that it is the Judge who is making the decision in the case and that all answers should be addressed to them. However, the questioning will come from the advocate. As soon as you take the stand, you should point your feet towards the decision-

maker. You should look at the person who asks you the question, by twisting your hips to face the advocate, and then turn back on each occasion to the Judge to give your response. When you have finished giving your answer, you should turn back to the advocate for the next question. This technique puts you in control, slows the pace down and allows you to focus on directing your answer to the person who is making the decision in the case.

3 Seek assistance of the decision-maker: You should address everything through the Judge. If you have not understood a question, or wish it to be rephrased, then this should be requested through the decision-maker. This is also a matter of respect of the fact that the decision-maker is presiding over the case. However, care should be taken by you if you feel that the question is irrelevant, inappropriate or indeed personal. Ultimately, it is for the Judge to decide, and not you, if a question is to be answered.

4 Communicate effectively: A court is not a natural environment. It is important to take time and speak clearly and slowly when giving evidence. In particular, avoid using jargon and technical terms. While addressing the decision-maker, remember they will often be taking notes. You may need to slow down in order to give them time to write. There is no microphone in court so you need to speak at an appropriate volume.

5 Assume nothing: You should not assume that the decision-maker has read or understood everything. You therefore need to take every opportunity when answering questions to elaborate and expand in order to ensure that you have given sufficient detail to the decision-maker.

6 Be ready for cross-examination techniques: The role of the cross-examining advocate is to try and limit or restrict an answer, look for flaws in the evidence and attempt to discredit your expertise. You should treat every question as an opportunity to give as much relevant detail as you feel necessary.

7 Techniques on cross-examination differ but may include interruptions, closed questions, multiple questions, hypothetical questions, or indeed an attack on your qualifications and expertise. The advocate may also try and undermine you through their tone of voice or gestures. By taking a moment before answering every question and directing your response towards the decision-maker, you can decide how much detail to give. If you have not understood the question or are interrupted before giving your full response, then you should seek the assistance of the decisionmaker. You can simply ignore any gestures or other theatrics designed to undermine you.

7 Don’t go outside your area of expertise

8 Answer honestly: You are under a legal obligation to tell the truth. This means, quite simply, if you do not know the answer to a question or cannot recall the details then you should express your answer in such terms. You should always be fair and balanced in the presentation of your evidence and should not to allow any personal views to creep in.

9 Stay calm: You need to remain calm, never arguing with the advocate regardless of their tone or possible rudeness. It is important to retain a professional approach in all discussions at court to project the image as a competent expert in the field of Chiropody and Podiatry.

Bond Solon is the largest provider of Expert Witness and Witness of Fact Training in the UK and have been involved in preparing witnesses in some of the UK and world’s highest-profile cases. Since 1992, over 250,000 witnesses have attended their programmes.

Bond Solon are delighted to have been invited to speak at the Institute of Chiropodists and Podiatrists Annual National Podiatry Conference between 11-12 May 2018 in Southport.

Bond Solon will be running a highly interactive session titled “Podiatrist in the Box” on 12 May.

Bond Solon Training | 5th Floor, 10 Whitechapel High Street, London, E1 8QS | www.bondsolon.com

Piers Lawson | Managing Director

Primary Care

PODARICK NAILS IT!

Podarick can you help me? What is Neuropathy?

Podarick says:

Neuropathy is a long-term condition affecting the nerves that may cause cramps, muscle loss/ twitching, and changes to bone tissue, skin, hair, and nails. There are over a hundred different types of neuropathy identified, and any of them are likely to cause neuropathic pain and loss of sensation in the body. Many types of neuropathy are “idiopathic,” where there are no known causes, but there are many conditions such as infection, inflammatory/ immune disease; erectile dysfunction, vitamin deficiency; injury, ischemia, alcohol and medications are some of the potential triggers. Diabetes is the most common cause of chronic peripheral neuropathy (diabetic neuropathy), due in part to high blood sugar levels damaging the nerves.

Peripheral neuropathy, is so named, as a result of the damage to peripheral nerves, which can cause weakness, numbness and pain, usually to the hands and feet. It can however, affect other areas of the body (polyneuropathy) when the central nervous system (CNS), does not communicate well with the whole body. Motor neuropathy can cause weakness, muscle twitching or loss, and affect unbalanced movements. Sensory neuropathy causes unusual or painful sensations, from prickling, tingling, burning or sharp pain; reduced feelings of sensation may also be felt, along with texture or temperature changes within the skin. Most neuropathy symptoms will usually occur first and most severely in the feet. Although, autonomic neuropathy, which depending on an affected body organ or gland may cause bladder problems, an inability to breathe or sweat normally; blood pressure or heart rate irregularities, etc.

Send your Nail Clippings to Podarick: c/o The Institute of Chiropodists & Podiatrists 150 Lord Street, Southport, PR9 0NP

The Institute of Chiropodists and Podiatrists

Certificate of Learning

The Institute of Chiropodists and Podiatrists would like to award members with a certificate of learning (for your CPD portfolio) in one of two ways:

(a) Reading an article in the current issue of the Podiatry Review and writing a reflective account of the article.

(b) Writing a case study.

If you would like to submit a reflective account of between 750 and 1,000 words on a published article printed in the Podiatry Review, or a case study. These submissions will be considered for publication in the Podiatry Review.

Please email pauline@iocp.org.uk

Diabetes Representative within the IOCP

The Institute of Chiropodists and Podiatrists currently has a vacancy for a Diabetes Representative. This is a voluntary position within the organisation and would suit someone with an interest in diabetes.

The role involves liaising with Diabetes UK on a regular basis and informing the Board of Directors on all the latest news and updates in this regard. Such important updates and information can then be passed on to the membership.

It is important therefore that applicants are computer literate and have access to the internet/email as you will be required to liaise with Head Office via email in order that relevant diabetic news can be circulated.

This is a very important role within our organisation. It will assist members, readers of Podiatry Review and the public in keeping up-to-date with relevant diabetic news and information which the Institute can publish.

Award of Consultant Fellowship of the IOCP

The Institute of Chiropodists and Podiatrists

Submissions are invited from members or academic fellows of the Institute pursuant to granting them additional recognition as a Consultant Fellow of the Faculty of Podiatric Medicine of the Institute of Chiropodists and Podiatrists (CFPodM).

Award

Consultant Fellowship is a clinical award for senior members of the profession, recognising and demonstrating their seniority and an advanced scope of clinical practice. The minimum attainments of individuals seeking the award must be as follows:

• They must be current registrants of the Health and Care Professions Council, in good standing, at the time of application without pending disciplinary action.

• They must be current full members or academic fellows of the Institute of Chiropodists and Podiatrists with current IOCP band 4 professional indemnity insurance.

• They must have a degree in Podiatry or Podiatric Medicine awarded by a UK university

• They must submit evidence of a pattern of continuing professional development throughout their career to date in subjects appropriate to podiatry.

• They must have Local Anaesthesia (POM-A) and Prescription Medicine (POM - S) annotations recorded on their HCPC registration entry. OR have POM-A and Supplementary Prescribing/ Independent Prescribing recorded on their HCPC annotations.

• They must have a minimum of 12 years of clinical practice as a podiatrist

• They must submit a curriculum vitae showing their journey through the profession to the date of application and this must demonstrate how they believe themselves to have a scope of practice that merits the title ‘advanced’

The award is via the agreement of the panel of Consultant Fellows of the IOCP who will ensure that all of the minimum standards have been met. Applicants will be required additionally to successfully undertake a telephone interview with a member of the panel, once all of the above bullet points have been met and the appropriate application paperwork submitted to the registered offices of the Institute. The award will then be formally issued upon payment of the nominal administration fee of £100.

Award of Academic Fellowship

The Institute of Chiropodists and Podiatrists

Award

Submissions are invited from members of the Institute pursuant to granting them additional recognition as a Fellow of the Faculty of Podiatric Medicine of the Institute of Chiropodists and Podiatrists (FPodM).

Application is by way of completion of the appropriate paperwork and submission of a 3000 word (+/-2%) dissertation containing previously unpublished material on a relevant podiatric subject that meets the approval of the Review Board of the Faculty of Fellows. Such dissertation is to be constructed on sound academic principles and be adequately referenced in an accepted academic style.

For members who have not previously published, the Board is happy to give informal and friendly guidance to members wishing to develop this interesting new area of their professional career. A nominal fee of £75 is payable to cover the necessary administration by Head Office. Certificates of Fellowship will be awarded to successful Fellows and their names recorded on the Roll of Fellows maintained by the Faculty.

Accepted dissertations will be published in Podiatry Review and be added to The Fellows Library which will be an electronic knowledge bank available online to registered members. Such activity is also held to be Continuing Professional Development (CPD) by the IOCP and is suggested as being suitable to record in the event of HCPC audit.

Applications will be accepted from current members who are HCPC registered, annotations such as POMs or LA are not a condition of application as this is an academic award open to all HCPC registered full members of the Institute.

For further information and an application form please contact Head Office by emailing Pauline@iocp.org.uk.

Most Popular

Steroid Injection

14th April 2018

Members £355 Non-members £380

This course is open to all HCPC registered chiropodists, podiatrists with LA certificates, Nurse practitioners, Medical Doctors, Physiotherapists, Independent Prescribers and is approved and certified by The Institute of Chiropodists and Podiatrists.

This course is a mixture of detailed theory of the Pharmacology of steroidal agents, comprehensive guidance on the parts of the foot and lower limb that can be treated, direct observation of procedural skills and ongoing assessment.

NEW

Viscosupplements

Sponsored by the UK’s supplier of ‘Ostenil’ Viscosupplement injections 2nd June 2018

Members £365 Non-members £385

The course is open to all LA qualified (POM-A) HCPC registered Chiropodists and Podiatrists from all organisations.

It is approved and certified by The Institute of Chiropodists and Podiatrists and the course will allow delegates to add this modality to their level four professional indemnity insurance provided by the Institute.This insurance covers administration to the knee joint.

Viscosupplements are used for mild to moderate osteoarthritis in synovial joints. This course will cover injections to various synovial joints of the foot and ankle as well as the knee and explains the science behind the substances used, the range of products available from TRB Chemedica, indications for their use, safety considerations, the selection of suitable patients and techniques of use.

Tutors: Martin Harvey and Somuz Miah Venue: The Institute of Chiropodists and Podiatrists, Southport

NEW

Dermal Fillers in the Feet

28th April 2018 New date 30th June 2018

Members £365 Non-members £385

This course is open to all HCPC registered chiropodists, podiatrists, physiotherapists, doctors, nurses, chiropractors and is approved and certified by The Institute of Chiropodists and Podiatrists. An LA certificate is required.

Injectable dermal fillers based on hyaluronic acid, such as Restylane® have now been used – with an impressive safety record - for two decades for purely cosmetic purposes of reducing the appearances of wrinkles in the face.

The action of this (and other) fillers can be utilised for the medical purpose of insulating or offloading points of pressure in the foot or toes. This course, led by Podiatrist Independent Prescriber Martin Harvey who introduced the first such courses for podiatrists nearly ten years ago, will show the mechanism of these substances and their clinical applications in Podiatry.

The substances used are medical devices so can be accessed and utilised by Podiatrists with an LA certificate.

Tutors: Martin Harvey and Somuz Miah Venue: Sir Robert Peel Hospital, Tamworth

Tutors: Martin Harvey and Somuz Miah Venue: Sir Robert Peel Hospital, Tamworth

Most Popular

Podiatric Acupuncture

7th and 8th July 2018

Members £360 Non-members £385

This course is open to all HCPC registered chiropodists, podiatrists, physiotherapists, doctors, nurses, chiropractors and is approved and certified by The Institute of Chiropodists and Podiatrists. An LA certificate is not required.

Learn when and how to utilise this procedure safely. Common conditions treated include:

plantar fasciitis

achilles tendon injuries

shin ‘splints’

calf cramping

arthritic joint pain as well as neuropathic pain, neuromas and ulcers

Tutors: David Lintonbon and Somuz Miah

Venue: The Institute of Chiropodists and Podiatrists, Southport

We Need your Patients!

Course places are limited - for further details tel: 01704 546141 or email: julie@iocp.org.uk

NEW New date 22nd Sept 2018

Platelet Rich Plasma (PRP)

Members £365 Non-members £385

This course is open to all HCPC registered chiropodists, podiatrists, physiotherapists, doctors, nurses, chiropractors and is approved and certified by The Institute of Chiropodists and Podiatrists.

Podiatrists with an LA certificate do not require further annotations to be trained in and use this useful technique.

This exciting one-day course covers the point-of-treatment collection, and preparation, of PRP and highlights its safe and effective use in intra-articular and peri-articular pathologies.

Led by Podiatrist Independent Prescriber Martin Harvey, who collaborated in research in 2007 and 2008 with USA based companies who were developing collection and preparation kits for the International market, the current course is supported by one of the UK’s principal manufacturers of collection and preparations kits.

Tutors: Martin Harvey and Somuz Miah

Venue: Sir Robert Peel Hospital, Tamworth

NEW

Foot Mobilisation

6th & 7th October 2018

Members £360 Non-members £385

This course is open to all HCPC registered chiropodists or podiatrists, physiotherapists, doctors, nurses, chiropractors etc This is two days of intensive practical training and includes:

Anatomy of lower limb

Manipulation of foot, ankle & knee

DVD of techniques

approved certificate • Course booklet

A podiatric joint manipulation/mobilisation technique is a gentle hands-on rapid forceful action to help restore foot and ankle joint mobility.

It is an effective and safe treatment for painful joints and stiffness due to tissues/ tendon injury. This technique can be beneficial with combined with other modality i.e. Prescription orthotics.

Tutors: David Lintonbon and Somuz Miah

Venue: The Institute of Chiropodists and Podiatrists, Southport

As members will know, we now run a comprehensive variety of postgraduate training courses in advanced practice, as part of the exciting and ever-expanding range of activities of the Institute’s Faculty of Podiatric Medicine.

Unlike the majority of courses from other providers, these are not ‘talk and chalk’ theory sessions but where possible include real patients being treated with real therapies, as demonstration models. The problem is we keep curing ‘em and using up our supply of models.

If you would like to put forward any of your patients for treatments for the knee, ankle and foot which include:

• Prolotherapy injections for sprains, strains and tissue damage

• Steroid injections for joint problems

• Viscosupplement injections for mild to moderate arthritis

• Botox™ injections for excessive sweating of the feet

Then please contact Julie at Head Office on 01704 546141 or email julie@iocp.org.uk for more information.

Treatments are entirely free of charge in return for the patient allowing students (fully supervised HCPC registered podiatrists) to watch, or in some carefully guided cases, administer, these treatments. You, as their practitioner can accompany them for the duration of their treatment if they and you wish. The full price of some of these treatments can be well in excess of a couple of hundred pounds so it can make them accessible to people who may be unable, or unwilling, to pay themselves.

An Institute trainer will contact you initially to discuss the proposed patient and answer any questions you or they may have. Patients must be willing to travel, at their own expense, to a training venue at the time specified on the training day.

Training venues are either :

a) The IOCP National Training Centre in Southport, Merseyside

b) Sir Robert Peel Hospital, Tamworth, Staffordshire

As appropriate to a specific course.

(but we promise to give them back in a hopefully better condition)

Systemic Arthritis and Foot Disorders

By Dr Iain B McIntosh, BA(Hons) MBChB, former Chiropody Schools Inspector

In most patient contacts, the podiatrist deals with localised disorder or disease, but hidden in routine presentations will be the occasional early harbinger of systemic disease. There will be a canary among the sparrows and the health professional has to be alert to localised manifestations of general disease. Prompt referral rather than immediate treatment may be appropriate, but the same patient will often require considerable podiatric care once the diagnosis has been confirmed and medication instituted. Chronic conditions with localised podiatric problems often require prolonged, skilled foot care. Several systemic diseases can present with foot and nail pain and problems. One is Rheumatoid arthritis (RA), an autoimmune disease causing pain and joint deformity. Cells of the immune system malfunction and attack healthy joints. Early signs are stiffness, pain, and swelling in the hands and feet. The onset is gradual for some and immediate for others and ultimately joints in the ball or sole of the feet become too painful to walk on. As the disease progresses, pain and stiffness may spread to many joints1

In RA, the immune system attacks the body’s own joint tissues, resulting in inflammation, with progressive damage to affected joints. It also attacks the fluid within joints as well as the joint lining, (the synovium). This becomes acutely inflamed, causing a warm and swollen joint. Continued inflammation, eventually thickens the synovium and causes cartilage and bone to erode, which leads to joint deformity and decreased range of motion. Muscles, tendons, and ligaments that surround and stabilise the joints may also weaken. Not everyone will have foot involvement with RA, but most sufferers are affected and in early presentation of the disease this can bring them to the podiatrist for attention. It is important that signs and symptoms of the systemic disease be recognised and prompt referral to family doctor and rheumatologist considered. Rheumatoid arthritis is the commonest type of inflammatory arthritis. Up to 90% of people with this condition will report associated foot problems.2 For some people, the foot is the first area of the body to present with signs and symptoms. Foot problems caused by RA commonly occur in the forefoot although RA can also affect other areas of foot and ankle. The most common signs and symptoms of RA-related foot problems, in addition to the abnormal appearance of deformities, are pain, swelling, joint stiffness and difficulty walking. RA typically changes a foot’s structure and shape. It affects the metatarsophalangeal (MTP) joints of toes. When persistently affecting the MTP joints, a gradual lateral shift in toes can occur. This causes feet to develop bunions (hallux valgus). RA may also cause shifting of the forefoot and loss of stability, leading to toe contractures, such as hammertoes. Toe contractures and changes in toe joint flexibility lead to calluses and pain beneath

the ball of the foot. Other joints of the foot that can be affected include the ankle joint and the talonavicular joint, part of the foot arch. The foot can become destabilised and flat feet (pes planus) can develop.

RA pain can be distinguished from osteoarthritis (OA). Multiple joints are usually affected at the same time with RA and the joint symptoms are generally symmetrical. Another feature is the tendency for RA to cause a longer period of morning stiffness with stiffness in affected joints for one or more hours after awakening, compared with the OA sufferer, whose joint stiffness may diminish after a few minutes of stretching or motion in the morning.

Heel pain is common in people with RA. It occurs at the back or underside of the heel. Associated conditions include heel spur syndrome (plantar fasciitis) Achilles tendonitis, and retrocalcaneal bursitis occurs, when a fluid-filled sac (bursa) behind the heel bone becomes inflamed, causing pain and swelling. Bursa can often be found under the ball of the foot affected by RA .When RA inflames the synovium, the swelling can compress nerves and cause symptoms of a pinched nerve (nerve entrapment).Tarsal tunnel syndrome is a common nerve entrapment in the foot. Symptoms include burning, tingling, or shooting pain in the area of the foot arch and sole. Splinter haemorrhages - small areas of broken blood vessels- may occur on sides of toenails. Rheumatoid nodules appear as a lump beneath the skin, usually over bony prominence or tendon. In the foot, they may appear over the Achilles tendon, in the heel pad, or on the side of the big toe if hallux valgus is present. Nodules forming in soft tissues may be susceptible to rubbing from hosiery and footwear. Shape changes in the front of the foot and the toes can create pressure sites that develop corns and calluses. 3.4

Summary:

Deformities and conditions associated with RA may include:

• Rheumatoid nodules, which cause pain when they rub against shoes or, if they appear on the bottom of the foot and pain when walking

• Dislocated toe joints

• Bunions

• Achilles tendon pain

• Hammertoes

• Heel pain

• Flatfoot ankle pain

Diagnosis RA is diagnosed on the basis of history and signs observed on clinical examination as well as blood tests, x-rays and/ or other imaging tests.

Treatment Pharmacological treatment can help in management, including its foot manifestations. Treatment focuses on medication prescribed by rheumatologist. The podiatrist can however do much to relieve pain and discomfort of RA-related foot problems. Podiatric care is aimed at reducing painful symptoms, supporting

joints of the feet and improving foot function. As well as a moulded insole, shoes roomy enough to accommodate foot and orthoses without adding unnecessary pressure are important. If toes are beginning to stiffen or curl, a shoe with an extra deep toe box is vital and protective shields for toes can relieve pressure and reduce friction.

Orthotic devices. The early use of orthoses and medical management, may slow the development of joint changes.5 Customised orthotic devices provide cushioning for rheumatoid nodules, minimize pain when walking and give needed support to improve the foot’s mechanics. e.g. individualised insoles. Treatment for RA type of bursa usually involves reducing pressure over the ball of the foot with the use of insoles or orthoses.5.6.7

Advice on appropriate shoe wear to relieve pressure and pain and to assist with walking.

Provision of appropriate padding to distorted toes and bunions

Treating of corns and calluses

Advice on exercise, which should be reduced when there are signs and symptoms of an acute ‘flare’

Osteoarthritis of the Foot Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints with inflammation. Pain may be accompanied by swelling, tenderness, stiffness. The most common form of arthritis to affect the big toe joint is osteoarthritis, caused by degeneration of the articular cartilage. Osteoarthritis at the big toe joint may develop from problems with foot structure and functioning, resulting in excess wear-and-tear. Trauma such as a fracture or dislocation of the big toe can also result in osteoarthritis.

Osteoarthritis is the most common type of arthritis affecting 14% of adults over 25 years and 34 % over 65. Seventy percent of people over 70 years old have x-ray evidence of osteoarthritis.1 OA is primary -underlying cause unknown (idiopathic) or secondary developing as a result of another medical condition or trauma at the joint e.g. a sports injury). Knees and hips are the joints most commonly affected by osteoarthritis. Pain and physical limitations make osteoarthritis a significant disease. Arthritis of the big toe is the most common site of arthritis in the foot, affecting 2.5 percent of people over the age of 50. The joint at the base of the big toe (MTP joint) is affected and the condition develops gradually over time.1

Some people with osteoarthritis will develop hallux rigidus, stiffness which usually affects adults between 30 and 60 years of age, and is often the result of a prior sports injury1. Sportsmen become susceptible to micro-trauma where loading, stressing, and extending movements are required of feet and sprains occur in the joint at the base of the big toe. “Turf toe,” the name given to these injuries, can also cause bone spurs or osteophytes to develop. Soccer and football played on artificial turf cause most toe injuries in sports. If not treated properly, turf toe can lead to hallux rigidus. People who have fallen arches, or excessive pronation of ankles, are susceptible to developing hallux rigidus. The marked stiffness of the joint, results in restricted big toe extension. If the arthritis advances, knobbly growths- bone- spurs may develop that resemble a bunion.

While bunions develop on the inside of the foot, bony spurs from advanced arthritis tend to form on top of the big toe joint. Like bunions, though, these bony enlargements can create a hallux valgus deformity in which the big toe points towards the second toe. Symptoms of osteoarthritis of big toe may include pain, a grinding sensation, stiffness, and swelling. Pain is generally most noticeable when standing and walking and there may be: -

• Pain, even during rest

• Pain which worsens with use of the big toe, such as with jumping

• Difficulty wearing shoes because of bone spurs

• Difficulty wearing high-heeled shoes

• Dull pain in the hip, knee, or lower back caused by changes in how someone walks

• Limping Treatment. As with other joints, treatment of foot osteoarthritis targets relief of symptoms. Losing weight if overweight helps all weight-bearing joints. Drug treatments, topical medications, intra-articular injections fusion, or joint replacement may be recommended.8The podiatrist will manage presentations as for RA cases. Wearing orthotics or foot supports may be helpful. Shoe modifications (for example, shoe pads designed to stop movement under joint of the big toe, stiff soled shoes which also reduce movement at the joint, or adding a rocker bottom to shoes) and judicious padding can alleviate pain and reduce friction and discomfort. Advice to minimise stress on joints by wearing well-cushioned shoes.  Choose shoes with lace-up fastenings or adjustable strap: There should be a centimetre between the end of longest toe and end of the shoe and room to accommodate any swelling and padding9

Gout is a metabolic condition that can affect the big toe joint, when uric acid builds up in person’s forming crystals, which deposit into the big toe joint. Symptoms of gouty arthritis include a red, hot, and intensely painful joint. If untreated and recurrent, joint damage may occur. In addition, gout tophi may form as visible and/or palpable urate deposits on the toe. It can be challenging to distinguish between a gouty arthritis in the big toe joint and an infected joint. An elevated blood test to check uric acid levels confirms a gout attack. Treatment. An acute attack can be treated with colchicine, an antiinflammatory and dietary intervention and appropriate padding and advice on footwear, Psoriatic arthritis. Nails can be affected in people with psoriatic arthritis and be a guide to diagnosis. Conclusion.

8

9

Introducing the College of Foot Health Ltd

Application for membership of the College of Foot Health is open to Foot Health Practitioners who can demonstrate a level of recognised training, practice and ethics that meets the high standards required. Membership is also granted to IOCP Associates and successful graduates from the Institutes Foot Health training program.  Individuals who do not currently fully meet the required standards may undertake additional training through the college and if successful be awarded membership.

Here are 10 Benefits of being a member of the College of Foot Health:

1 All Foot Health practitioners can apply to join The College of Foot Health industry

leading malpractice Insurance Cover Scheme.

2 Members receive quarterly issues of Podiatry Review, which can contribute to your Continued Professional Development.

3 The annual conference and AGM is an excellent source of professional development: including lectures, workshops and master classes (plus a great dinner dance!)

4 Members receive Continuing Professional Development Support– Guidance and assistance with the members continuing professional development portfolio and a 20% discount on Elsevier academic books

5 Members can enjoy Business Support from our advice partners.

6 Access to the members area of the Institute website, which contains the latest news, information, online Continuing Professional Development and discussion forum

7 Members can join the IOCP ‘Find a practitioner’ service to promote your business to members of the public finding the IOCP website through search engines.

8 Members can Network through local member branches, situated throughout Britain, Northern Ireland and the Republic of Ireland for peer support and CPD events

9 Members have access to a confidential advice service, including advice from the IOCP medicines and procedures panel

10 Members are eligible for The Institute’s awards scheme

Interested parties should apply to the Secretary at IOCP Head Office.

National Leads Required

The concept of ‘Leads’ in healthcare organisations is well established, and such Leads become a focal point for incoming information concerning a specific element of professional activity, for example: diabetes, peripheral neuropathy, safeguarding, mental health, equality and diversity etc.

Leads should have an interest in or experience of, an area that they wish to become Lead for (or be willing to develop knowledge of it) and be willing to be named as the contact point for information that comes into the IOCP from Government, other professional bodies and organisations or the media.

It would then be the responsibility of the Lead to advise Head Office, the Executive Board, and our editorial team for the Review and website, of items of information that they consider worthy of dissemination to the wider membership or flag up to staff or Board members that they should consider further action in a specific area. For example, new guidelines on a subject may be published that the whole membership should be made aware of etc. As Leads gained further knowledge in their specialist area, it is hoped that they could be approached as a source of advice by staff and directors - and indeed other professions or the wider mediawhen specialist knowledge was needed.

Head Office will assist with any administration that is required, but it is expected that there will not be onerous amounts of it.

As the leading democratic podiatry organisation in the UK, run by members, for members, this is yet another example of how all members have the opportunity to involve themselves in the activities of our organisation and continue to develop it to even greater heights.

As with all voluntary positions held by members (including Executive Council members), there is no remuneration, but you will be making a real contribution to our continued professional growth and the growth of the wider profession. Such activities naturally also count as CPD.

If you are interested please contact Julie at Head Office by phone or email, currently we are seeking to recruit national leads in:

• Mental Health • Biomechanics

• Safeguarding • Equality issues

• Podiatric Surgery • LGBT issues

Regulated areas such as podiatric surgery and biomechanics require HCPC registered members, Associates are most welcome to apply for areas such as mental health, safeguarding, equality and LGBT issues.

As part of the continuing expansion and development of your professional body, we are inviting interested members to take on various National Lead positions.

Forms & payment can be completed online via our website or by filling in the form below and following the instructions.

Friday 11th May 2018

9.30 – 10.30

Workshop: ”Growing your business through effective messages” by Tony Gavin, OSGO

Lecture: ”Dementia Friends” by Linda Lawson, Alzheimer’s Society 11.00 – 12.00

Lecture: ”Red flags of the foot and lower extremity” by David Lintonbon, DO, PGCert(ClinEd) Workshop: ”Setting a price in private practice” by Jonathan Small 14.00 – 15.00

Lecture: ”Achilles Tendinopathy” by Daniel Lawrence, Rocktape Workshop: ”Lacuna Method for fungal nails” by Nicola O’Brian, Love your feet CPD courses 15.30 – 16.30

Lecture: ”Anatomy & examination of the spring ligament /tendon of muscle tibialis posterior” by Michael Ratcliffe, Cuxson Gerrard Lecture: ”Management of Plantar Hyperhidrosis” by Dr Richard Oliver, STD Pharmaceuticals

Booking

Saturday 12 May 2018

9.00 – 10.00

Lecture: “Verruca? Verrucae? Verrucee?.... Plantar warts” by Belinda Longhurst Workshop: “Flexitol – a range to add value and profit!” by Caroline McGowan, Flexitol Lecture: “Introduction to platelet rich plasma” by Martin Harvey 10.00 – 11.00

Workshop “Our role in fall prevention” by Olga Frankowski, Medifoot CPD School Workshop: “Emtrix - update on research including Nail Psoriasis” by Steve McGowan, Moberg Pharma Workshop: “The pelvic equilibrium theory - a new pardigm” by Clifton Bradeley, Sub-4 MD 11.30 – 12.30

Workshop: “Cosmetic podiatry - a beautiful way to diversify your practice” by Nicola O’Brian, Love your feet CPD courses

Lecture: “Clinical management and self management of Raynaud’s / Scleroderma in the foot” by Tracey Spray, SRUK Workshop: “Podiatrist in the Box!” by Catherine Brown, Bond Solon Training (NEW for 2018) 14.00 – 15.00

Workshop: “Action in Clinical Emergencies” 2 hours by Martin Harvey Workshop: “Safeguarding children and adults” by Somuz Miah Workshop: “Medical cuppings for the lower limb” by Abid Ali 15.30 – 16.30

Lecture: “First principle & innovative business thinking to develop a mega practice” by Clifton Bradeley, Sub-4 MD) Lecture: “Naloxone saves lives” including an open Q&A on substance/alcohol/POM misuse by Dr Carola Sander-Hess

2018 Annual General Meeting Nominations for National Office

President

Mrs Linda Pearson, Western Branch

NOMINEES

Vice-Chairman, Executive Committee

Mr Abid Ali, Birmingham

Chairman, Board of Education

Mr Andrew Williams, Cheshire, North Wales Branch

Vice-Chairman, Board of Education

Ms Beverley Wright, Essex Branch

Standing Orders Committee

Mr Michael Franklin, South Wales & Monmouth Branch

A new rapid diagnosis technique for dermatophyte nail infection

Ivan Bristow PhD Podiatrist & Visiting Fellow, University of Southampton

Fungal nail infection (Figure 1) is a common clinical problem and is thought to affect between 2-8% of European adults (1). The condition is frequently a progression of chronic tinea pedis where skin infection from the sole of the foot and inter-digital area has gradually spread into the nail bed under the free edge of the nail proximally, and progressing under the nail. Dermatophytes are responsible for over 90% of all toenail infections - the most common species being Trichophyton rubrum, Trichophyton interdigitale and Epidermophyton floccosum.

Before treatment can commence it is important to establish a proper diagnosis – this is recommended in published guidelines in the management of fungal nail infections (2) because it offers substantial evidence of fungal infection, reducing the risk of misdiagnosis. In private practice, if the diagnosis is not secured patients may be undergoing (and indeed paying for) a treatment that they don’t need. Those in foot care see a lot of fungal nail disease and generally are probably feel quite adept at diagnosing the condition. However, it is important to remember that 40-50% or more of nail dystrophies are not caused by fungal nail infection (3) so a proper diagnosis is key as half of the nail problems seen in clinic may not be fungal in origin.

Many chiropodists/podiatrists will assume that they can easily detect a nail infection just by looking but how effective is that? In a published study using experts it was found that

visual diagnosis at best it is 67% successful (4). Although relatively high, it still means statistically that one in three diagnoses of fungal nail infection by a chiropodist/podiatrist will be incorrect.

In order to secure a diagnosis a clipping needs to be taken from the affected nail and sent to the laboratory for two tests – microscopy and culture. Firstly, for microscopy. Samples are visually analysed under the microscope after application of potassium hydroxide and a stain of calcofluor white observed under UV light (5), to identify the presence (or absence) of fungal elements. The results of this can be obtained within a few days but this test only identifies the presence of a fungus.

The second part of the test is the culture where the nail sample is then placed on a dextrose agar plate and then cultured at 37° centigrade to encourage growth of any fungus present. If this is the case, then the species may be identified and reported back to the clinician. This can take 2-3 weeks. The result is considered positive for dermatophytes if either the culture or microscopy is positive although some argue that culture enables a more solid diagnosis as it confirms viable fungus exists in the nail and it can be readily identified (6).

The downside to culture, as many clinicians know, is the high false-negative rate – suggested to be around 30% or more which coupled with the time delay involved makes this test less attractive for regular clinical use. Culture failure can be due to a number of reasons. In one study of four podiatrists sampling technique, positive culture results ranged from 25-60% (7). The test also relies on sufficient amounts of nail sample to be made available to the laboratory for testing. Finally, the test itself can be costly to the practitioner to undertake.

A recent development in this field has meant that chiropodists and podiatrists can now undertake rapid testing for dermatophyte nail infection using a simple test in clinic without the need for a laboratory. The Dermatophyte Test Strip (JNC Diafactory, Japan) is a quick method to establish if dermatophytes are present in a nail sample. Unlike traditional methods, the test does not use microscopy or culture to detect fungal infection but a technique called immunoassay.

mentagrophytes, T. rubrum, T. tonsurans, T. violaceum, T. verrucosum, Microsporum gypseum, Microsporum canis and Epidermophyton floccosum). Collectively these species are responsible for over 99% of all UK dermatophyte infections (10). So how does it work? The test works by immuno-chemistry which is a common technique applied to other clinical tests such as pregnancy and drug testing kits. Within the test strip there are antibodies designed to specifically detect the presence of dermatophyte protein. If any is present, they will force the colour change in the paper indicating a positive result.

Ultimately, the test has the following advantages:

1 High levels of accuracy ensure a proper diagnosis is secured.

2 Undertaken in clinic and allows for a diagnosis in just five minutes.

3 Cost effective – each test is cheaper than standard laboratory testing.

4 The test has been shown to detect 8 different species of dermatophytes which collectively make up 99% of dermatophyte toenail infections.

5 Unlike culture and sensitivity, it can be used even if the patient has been applying antifungals to the nail.

6 The test can be purchased by the podiatrist and the patient charged directly so increasing business / practice turnover.

A sample of diseased nail is taken from the patients nail and added to the disposable test tube (figure 2) and a few drops of solution is added to soften the nail and release any fungal elements into solution (figure 3). The sample is then stirred (figure 4). Next, a test strip is added to the test tube and is left in situ for five minutes (figure 5). After that time has elapsed, a pink line will be evident to indicate that the test has been activated. The presence of a purple-brown line beneath it indicates if a dermatophyte nail infection is present (figure 6) whilst no purple-brown lines signifies a negative result (figure 7).

The main question that logically follows is how accurate is the test? The Dermatophyte Test Strip has been tested in two clinical studies comparing it to traditional methods (microscopy and culture) and against more advanced laboratory testing (Polymerase Chain Reaction) (8, 9). The results from this work have shown it to be 97.2% accurate when compared with these techniques suggesting it to be a useful clinical test for diagnosing dermatophyte nail infection. The test can detect eight species of dermatophytes (Trichophyton

REFERENCES

1. Ameen M. Epidemiology of superficial fungal infections. Clin Dermatol. 2010;28(2):197-201.

2. Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014;171(5):937-58.

3. Walling HW, Sniezek PJ. Distribution of toenail dystrophy predicts histologic diagnosis of onychomycosis. J Am Acad Dermatol. 2007;56(6):945-8.

4. Tsunemi Y, Takehara K, Oe M, Sanada H, Kawashima M. Diagnostic accuracy of tinea unguium based on clinical observation. The Journal of Dermatology. 2015;42(2):221-2.

5. Public Health England. UK Standards for Microbiology Investigations. Investigation of Dermatological Specimens for Superficial Mycoses. 2015.

6. de Berker D. Fungal Nail Disease. N Engl J Med. 2009;360(20):2108-16.

7. Arnold B, Kianifard F, Tavakkol A. A comparison of KOH and culture results from two mycology laboratories for the diagnosis of onychomycosis during a randomized, multicenter clinical trial: a subset study. J Am Podiatr Med Assoc. 2005;95(4):421-3; author reply 3-4.

7 As a diagnosis is secured whilst the patient is in chair, a treatment plan can be formulated and commenced immediately with no wait for results.

The next stage, if positive, is obviously to inform the patient of the dermatophyte infection and discuss the various treatment options available such as oral or topical antifungal drugs, nail trephination using the Clearanail® device (11), nail surgery or laser treatment. It is always important to remember that adequate treatment of dermatophyte nail infection relies on a clear diagnosis, but also eradication of potential risk factors. This includes educating the patient about recognising and treating any re-occurring tinea pedis as this is often the main source of nail infection and recurrence following successful treatment. Various studies have highlighted how prophylactic treatment of tinea pedis can be successful at reducing recurrence of fungal nail infection (12, 13).

Authors Blog: www.foot.expert

8. Tsunemi Y, Takehara K, Miura Y, Nakagami G, Sanada H, Kawashima M. Screening for tinea unguium by Dermatophyte Test Strip. Br J Dermatol. 2014;170(2):328-31.

9. Tsunemi Y, Hiruma M. Clinical study of Dermatophyte Test Strip, an immunochromatographic method, to detect tinea unguium dermatophytes. The Journal of Dermatology. 2016;43(12):1417-23.

10. Borman AM, Campbell CK, Fraser M, Johnson EM. Analysis of the dermatophyte species isolated in the British Isles between 1980 and 2005 and review of worldwide dermatophyte trends over the last three decades. Med Mycol. 2007;45(2):131 41.

11. Bristow IR, Baran R, Score M. Rapid Treatment of Subungual Onychomycosis Using Controlled Micro Nail Penetration and Terbinafine Solution J Drugs Dermatol. 2016;15(8):974-8.

12. Shemer A, Gupta AK, Kamshov A, Babaev M, Farhi R, Daniel CR, et al. Topical antifungal treatment prevents recurrence of toenail onychomycosis following cure. Dermatologic Therapy. 2017;30(5):e12545-n/a.

13. Sigurgeirsson B, Olafsson J, Steinsson J, Kerrouche N, Sidou F. Efficacy of amorolfine nail lacquer for the prophylaxis of onychomycosis over 3 years. J Eur Acad Dermatol Venereol. 2010;24(8):910-5.

History corner

“Practical Podiatry”

Philip Basham, BA, FinstCh Jean Truscott, BA, FinstCh

Introduction

Radical procedures such as those described herein should not be considered as alternatives to conservative chiropodial measures. The paramount consideration is always effectiveness combined with simplicity and the least invasive technique commensurate with that primary consideration.

“Usually, the patient may continue his regular occupation with little or no disability. He may stay in his own home making a considerable saving in money and convenience. The worry and dread of a hospital stay is avoided. Fewer complications develop. Saves hospital space for those actually needing bed and nursing care.

Smallness is not at all synonymous with unimportance and the surgeon must constantly be on his guard. Operations upon patients with blood dyscrasias, such as haemophilia or leukaemia, even though the lesions are insignificant, are best performed in the hospital because of the danger of post-operative bleeding. In diabetics, even minor operations should be performed in the hospital because of the danger of metabolic complications.

Ambulatory surgery should be safe surgery.”

The deployment of diagnostic skills in the evaluation of the condition and patient suitability is essential. The practitioner’s expectation of a satisfactory prognosis is not simply dependent upon his surgical skills, but also upon his care in patient selection. In statistical argument it is often claimed that chiropodial/podiatric patients are self-selecting; this may be true but the treatment is chosen by the practitioner.Where one or more alternatives may be equally effective discussions with the patient should incline the decision towards conservative treatment whenever possible.

The podiatric procedures described in this small volume are those which have proved themselves over a period of years in the author’s own practice. There are many alternative procedures used by other podiatrists; we merely claim proven success for these procedures that have brought relief to a large number of our own patients.

It is not intended that this short book should be used as an instructional manual by those who are inexperienced in surgical methodology. Rather we would wish it to be used as a stimulant to discussion about alternative ways of treating conditions commonly occurring in the foot.

There is no substitute for the practical experience to be gained from working with an experienced operator. The authors will be forever indebted to the late Mr Alan Proctor for the practical techniques they acquired under his skillful tutelage.

Simply because there is loss of sensation in a digit which has been anaesthetised there is no excuse for forgetting the human being attached to that digit; at all times a caring attitude to the patient should be paramount.

We include the quotation (left) from the book Surgery of the Ambulatory Patient by L.K. Ferguson: Lippincott Co because we feel that we cannot improve upon this statement and because we totally agree with the content:

Foot operations performed by Podiatrists are not normally life and death affairs, although successful results can certainly improve the quality of life. We therefore cannot stress enough our point that operative procedures such as those described within this book should only be carried out where they can reasonably be expected to be more successful than any other treatment and where they can be carried out with no undue risk.

Chapter 1

Equipment and environmental considerations

It is a tenet of chiropody that a sharp blade and a steady hand makes an effective practitioner: this is also a sound principle in podiatry. Additionally, familiarity with the instruments used is an essential ingredient in the deployment of skills. Some of the instruments which are employed in podiatric procedures may be unfamiliar to the reader. We have, therefore, taken care to describe all the instruments utilized in this book. The environment in which these podiatric procedures are carried out is of primary importance. A room in which routine chiropody work is done would be totally unacceptable. Reducing the risk of infection to a minimum is only possible when a separate room devoted entirely to podiatry is maintained. The operating theatre should house only the essential equipment, ie. operating chair or couch, mayo table or trolley, the x-ray viewer and the operating lamp. When space is at a premium, as is often the case, the autoclave and the instrument cabinet can also be permitted. Items which never should be kept in the operating room include all paper and linen. Caps, gowns, masks and gloves must always be kept in the scrubroom or anteroom, since that is the place where they are donned before entering the theatre. Dressings and drugs and any other items necessary for the operations may be stored near but not in the theatre itself. Only those items essential for the procedure in hand should be moved into the operating area at the appropriate time.

It is prudent to make sure that a duplicate set of readysterilised instruments is easily available in case of accidents.We all have an attack of “dropsy” at times. Obviously, it is also wise to have a back-up set of all equipment used.

Scrub Area Equipment

Wash basin with running h & c water

Wrist or elbow taps

Nail brushes – sterilisable

Suitable germicidal cleaning agent Hot air hand dryer

Sterile towels – preferably disposable Waste bin – foot operated

Theatre Equipment

X-ray viewer

Autoclave for sterilising instruments

Operating chair/table that can be raised to required height, foot controlled Operating light

Operating table (Mayo or similar) seamless, stainless Dressings trolley - steel is preferable Foot-operated waste-bin - stainless steel Ambu bag Brook airway

Disposables

Surgical drapes – autoclaveable

Steri-bags – assorted sizes

Autoclave tape

Congratulations Rosalie Quijano Tio

Rosalie Quijano Tio has been an overseas member of the Insitute for over 15 years. Rosalie completed her initial training with Scholl/ IOCP in 2000, and gained her HCPC registration through the grand parenting window as many of us were. Upon completing her training Rosalie returned to Singapore and set up her successful chiropody/podiatry business.

In 2011, Rosalie moved to Melbourne, Australia to apply to do a 4 year full time double degree programme out of La Trobe University. Rosalie was accepted onto the course with a start date of February 2012.

In November 2016, Rosalie sat her final papers and handed in her dissertation on Diabetes in the Asian population, obtaining her BSc in Science and a Masters in Podiatry. Her graduation ceremony was held in Melbourne Australia in May 2017. While doing her course Rosalie and 3 other students presented a power point presentation on wound dressings coming first, La Trobe was so impressed with this presentation they are including it within the course.

Rosalie received a Special Award from The Institute on 5th May 2017 in recognition of all her achievements within the podiatric profession. She has managed to do this with the support of her husband David, who has continued to work in Singapore, while Rosalie has been studying, and daughter Danica who is hopefully following in her father’s footsteps, and start her training to becoming an osteopath. Now Rosalie has completed her double degree programme, she is back in Singapore.

Press release: New strategy supports Allied Health Professionals to ‘blaze a trail in research’

A new strategy published by the National Institute for Health Research (NIHR) Clinical Research Network (CRN) will support Allied Health Professionals to ‘blaze a trail in research’.

The NIHR CRN Allied Health Professionals Strategy 2018-2020 sets out five strategic goals focusing on leadership, research capacity and capability, patient and public access to research, innovation, and building strong partnerships.

Anthea Mould, NIHR Clinical Research Network, Head of Allied Health Professionals, said:

“This exciting new strategy is all about supporting Allied Health Professionals working with, and for, the NIHR Clinical Research Network (CRN). AHPs already play a vital role in the delivery of high quality, patient centred clinical research; they are working in a breadth of roles, driving best practice, and linking in with a wide range health and social care networks. This strategy looks to build on that strong foundation.

“We want Allied Health Professionals to blaze a trail in research, develop as visible leaders and strengthen their impact across the health and research system. Whether it’s a two-minute chat with a patient about research opportunities, or supporting the delivery of someone else’s research, these activities are just as valuable as leading your own research study.

Professor Ann Moore CBE, Director of the Council for Allied Health Professions Research, said:

“The new NIHR CRN Allied Health Professionals strategy is extremely welcome and significantly complements the work carried out by The Council for Allied Health Professions Research (CAHPR).

“Whilst AHP research is increasing, the focus on leadership in research is key as we to aim to get more AHPs involved in, or leading, well-grounded research projects in all settings. CAHPR looks forward to working with the NIHR in support of this exciting and innovative strategy.”

AHPs represent the third largest professional workforce in health and social care.

The strategy reflects the NIHR mission “to provide a health research system in which the NHS supports outstanding individuals working in world class facilities, conducting leading edge research focused on the needs of patients and the public.”

The strategy draws on the experiences of those working across the CRN and sought views from strategic partners, including the Council for Allied Health Professions Research (CAHPR). It complements existing NIHR reports and also seeks to build on initiatives led by partners, such as NHS England’s ‘Allied Health Professions into Action’.

Reference: 1. NICE NG19 Diabetic foot problems: prevention and management.

Nottingham Branch Study Day

Sunday 15th April 2018

Venue: The Function Room of The Wolds Pub & Restaurant, Loughborough Road, West Bridgford, Nottingham NG2 7HZ

This is a FREE Study Day for the members of Nottingham Branch being subsidized from Branch funds and at a very low cost to other Branches and non IOCP practitioners at £20.00 for great CPD and a friendly professional day.

Registration: 9.30 am with coffee and croissants

Presenters: Lupus UK [East Midlands] – Mrs Gill Woodford

Steve McGowan – Emtrix Caroline McGowan – Flexitol Michael Ratcliffe – Cuxson & Gerrard – demonstration of Kinesio Taping

Lunch: 1.00pm – 2.00 pm

Presenter: Michelle Weddell, Lecturer in Podiatry, Birmingham - Skin Pathologies

Break: Coffee and muffins

Michelle Weddell, Lecturer in Podiatry, Birmingham - Pharmacology

Close of day: 5.00 pm with attendance certificates issued. Result of £1 draw!

We are delighted to have the attendance of Mrs. Linda Pearson, President IOCP, at our Study Day.

Non-Nottingham Branch bookings and enquiries should be directed to: Valerie Dunsworth, Branch Secretary on email: adunsworth@btinternet.com

Nottingham Branch members only bookings, as earlier advised to annesparkes@yahoo.co.uk

Are you ready for GDPR?

GDPR (General Data Protection Regulation) will apply in the UK from May 25th 2018 and is for those who have day-to-day responsibility for data protection. For further information please visit the ICO website www.ico.org.uk/for-organisations/data-protection-reform/ overview-of-the-gdpr/.

You can also find more information on resources and support available to you.

ICO publishes a wide range of leaflets, notes etc. for both individuals and organisations. All their publications are available free of charge. If you wish to receive copies by post, please follow the link and complete the online request form. ico.org.uk/global/request-publications

Membership details

If you have recently changed any of your personal details, such as those listed below, please would you advise Head Office, either by email, telephone or letter so the details we hold for you can be updated. Please ensure you include your IOCP membership number on all correspondence.

• Name, Address, Marital Status

• Telephone Numbers (Land line and/or Mobile)

• Email address (Home and/or work)

• Business address details

• HCPC (registration OR de-registration)

• Insurance

• Changing your working status from ‘ACTIVE’ to ‘NON-ACTIVE’ or vice versa

Note to Branch Secretaries: should a member contact you directly to amend their personal details please advise Head Office.

Please

remember to log on to the members’ area of the website to find out more about what’s happening in your Institute.

If you are having any problems logging in, please contact Head or email

COLLEGE OF FOOT HEALTH BADGES

New badges are now available from Head Office at a cost of £6 per badge.

APPEAL FOR PHOTOGRAPHS

Do you have any foot-related photographs that could be used on our website and/or within this journal?

If so, we would love to hear from you. Prior to submission of any photographs, you would be required to ensure that you have written consent from the client/patient that you can submit them for use by IOCP?

WINNER OF THE SCHOFT COMPETITION

We are pleased to announce that Mrs Agnes Wright (West of Scotland Branch) was the winner of the recent Schoft Competition and is now the proud owner of this new innovative seat belt accessory.

PODIATRY REVIEW

–Opt out of postal copy

We are interested in hearing from any member who would like to opt out of receiving a hard copy of the Podiatry Review and prefer to access it via the members’ area of the website (with availability to download a pdf copy). To register your interest, please contact Head Office or email pauline@iocp.org.uk

WEBSITE

Have you logged in to the members’ area of the website recently?

If not, why not pay a visit and find out more about the exclusive Members’ Benefits that are available to you.

IOCP Website - Find a practitioner

If you would like your details to appear on the IOCP’s website, www.iocp.org.uk ‘Find a Practitioner’ section and they don’t already, please email:secretary@iocp.org.uk

Alternatively, please telephone: 01704 546141

Please include your contact details, membership number and the practice details.

Linda (Jenny) Reid

I have been lucky enough to have known Jenny (Linda) Reid for the best part of twelve years.

She had always been ready to lend a hand and took part in our very first IOCP Open Day, even helping out at our National Podiatry Conference.

Jenny was a very respectful lady and was happy to offer her advice, experience and to offer solutions and ideas and will be missed by many.

Our thoughts and prayers are with her husband Tommy at this sad time.

Linda Pearson President

Western Branch, of the Institute of Chiropodists and Podiatrists, are saddened to announce the sad loss of one of its valued members, Linda Reid, more commonly known to her friends as ‘Jenny’.

I’m sure a lot of members will remember Jenny as she was an active member who always helped out at the Institute’s national AGM and Conference.

Jenny was diagnosed with pancreatic cancer for which she fought a long battle, however, on 24th February 2018 she sadly succumbed and passed away peacefully at St Joseph’s Hospice in Thornton. She leaves behind her beloved husband Tommy.

Never letting her cancer stop her from doing anything, Jenny continued working right up until Christmas, at her Bold Street clinic where she’d practiced for the last 15 years.

Over the past 25 years, Jenny had actively fundraised helping orphans and families in Romania any way she could, and in 2016 she was invited to a wedding there by a family whom she had helped and was welcomed with open arms. Needless to say, she had a fabulous time.

She really was a very caring and compassionate person with a lust for life. She enjoyed travelling to Italy and was a massive Trekky fan!

Jenny will be sadly missed by our Branch and anyone who knew her.

Western Branch

It was with great sadness that we learnt of the passing of Jenny Reid. We first met Jenny at the IOCP’s 2015 Conference in Southport at which she helped us on the reception desk. In the years that followed, Jenny was always willing to lend a hand whenever she could at any IOCP event here in Southport and it was a great opportunity for us all to catch up on everything.

A ‘lady’ in every sense of the word and such a lovely person who will be sorely missed by all who had the pleasure of knowing her.

We send our sincere condolences to Jenny’s husband Tommy at this difficult time.

Jill, Julie & Pauline Head Office

Western Branch Meeting - Sunday 14th January

On Sunday 14th January, fifteen members of the Western branch of the Institute of Chiropodists and Podiatrists came together for the first time in 2018, for the amalgamated annual general meeting and the branch meeting.

Before we commenced with business though, Ben Stead from Canonbury gave us a very informative talk on a revolutionary new treatment for the removal of verrucas. The machine in question is called “Swift” (for obvious reasons) and uses microwave technology. According to Ben, the results are incredibly successful and more and more clinics around the country are embracing its success. It is a portable machine, slightly larger than a chiropody drill and very light so supposedly suitable for those amongst us that only do domiciliary visits.

After a short break for refreshments with a sumptuous buffet, we had the opportunity to have a mooch at the Swift machine itself and purchase from the trade stand supplied by Ben from Canonbury. We then ploughed on with the AGM. Rachael Littleton, our secretary, went through all the relevant business from Head Office and we then continued with our branch meeting. The roles of office were discussed and voted for and I’m delighted to say that some new volunteers came forward to help share the responsibilities with the same old faces! We welcome them with open arms. Our treasurer Kevin O’Sullivan then gave his report on balancing the books as efficiently as ever. Thank goodness he has volunteered to carry on with his role for another year as I’m sure there’s no one amongst us that can do the job as well as he can!

We as a branch have an annual “star” award, voted for by our members and I’m pleased to say this year it was won by Rachael Littleton in recognition of her hard work as branch secretary over the past year.

When all the business was dealt with, the Institute’s President, our very own Linda Pearson gave us a very informative talk on the history of the Institute of Chiropodists and Podiatrists from its beginnings in 1955 to present day. She went on to explain how important the role of President is within the Institute and the duties she carries out to fulfil her role. Did you know that Linda is one of only four women that have ever held the role of President and is also the youngest!

I and the rest of my colleagues would like to give a very big thank you to Ben Stead for giving up his valuable time at the weekend for the benefit of the Western branch members. We very much appreciate it.

The next meeting is on Sunday 29th April and as this is an audit year it would be very beneficial to come along and gain the necessary cpd by joining us. All members welcome.

Leeds Branch Meeting - 7th January 2018

With a few last minute unexpected changes to our original schedule, we welcomed 32 attendees to this year’s Leeds Branch Seminar which was held at our usual branch venue in Batley. Our morning lecture was given by Mr Andrew Williams a consultant in podiatric medicine and musculoskeletal science, who gave us a very informative talk on common foot and ankle problems. Covering conditions such as tendonpathy, metatarsalgia and plantar fasciitis giving us a basic talk about his experience in dealing with these problematic foot ailments. Andrew is currently the Chair of the consultants committee and Chair of procedures and medicine panel for the Institute of Chiropodists and Podiatrists.

Before Andrew continued with the second part of his lecture he presented Norman Hodge with his life membership award from the IOCP, for all his hard work and commitment to the Institute over the years.

It was also a great opportunity to catch up over a coffee with not just some of our Leeds members, but members from other branches that had

attended. These events are not only a vital part of our CPD but gives us chance to network with other like-minded peers, plus meeting and interacting with other branches.

Lunch was supplied by a local company so we could all indulge in sandwiches, quiche, cheese and cakes!

Our afternoon lectures were given by Beverley Wright. These were split into two parts, first was Reflexology for Relaxation. Beverley demonstrated a simple relaxation technique for the feet which we can implement in our everyday practices. The second was an Aromatherapy Workshop, testing our noses and sense of smells with different aromatherapy oils and explaining how we can use these oils in our practices safely but effectively. Beverley is the Vice-Chair Board of Education for the Institute of Chiropodists and Podiatrists as well as senior lecturer at one of the largest Universities in the east of England.

Over all despite the last-minute changes the course ran very smoothly and hopefully was enjoyed by all.

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DIARY OF EVENTS

APRIL 2018

8 Leeds Branch Meeting

9.30am for a 10.00am start at St Mary’s Social Club, Melton St, Batley, West Yorkshire, WF17 8PT. Contact Caroline on 07583 934468 for further information.

8 Cheshire, North Wales Branch Meeting

10.15am at the Dene Hotel, Hoole Road, Chester. Contact: Michelle on 01704 540614 for further information

15 Nottingham Branch Seminar Day

At Anthony Eaton & Associates, Feet & Co, 85 Melton Road, West Bridgford, Nottingham. NG2 6EN

Contact Valerie on 0115 931 3492 for further information

16 North West Branch Meeting

At 7.00pm at St Joseph’s Parish Centre, Harpers Lane, Chorley. PR6 0HR

Contact Alison on 01772 623180 for further information

19 Sheffield Branch Meeting

At 7.30pm at Heeley Sports and Social Club

Contact Helen on 07789 025022 for further information

22 Sussex Branch Meeting

At Somers Vintage Tea Rooms, 64a High Street, Lindfield. RH16 2HL

Contact Dylan on 07759 535388 or Linda on 01323 646611 for further information

22 Devon & Cornwall Branch Meeting

At the Exeter Court Hotel, Kennford Exeter EX6 7UX. Lecturer to be confirmed.

Contact Mark Smith on 01803 520788 or Email mrkjoanne@ aol.com for further information.

27 Teesside Branch

At 7.30pm at 46 Blackwell, Darlington. DL3 8QT

Meeting

Contact Jon on 01287 349517 for further information

29

Western Branch Meeting

At 12 noon – 3pm at Liverpool Women’s Hospital

Contact Rachael on 07984 534264 for further information

29 Leicester & Northants Branch Meeting

At Kilsby Village Hall, Kilsby

Contact Barbara on 07790 350109 for further information

29 South Wales and Monmouth Branch Meeting

2pm until 4pm at Insole Court, Fairwater Road, Llandaff, Cardiff. CF5 2LN

Contact Esther on 01656 740772 for further information

MAY 2018

11-12 IOCP Conference and Annual General Meeting

Southport Theatre and Convention Centre, The Promenade, Southport. Merseyside. PR9 0DZ

Contact: Julie on 01704 546141 for further information

20 Essex Branch Meeting

2pm at the Southend University Trust Hospital Education Centre Carlingford Drive, Southend-on-Sea, Essex SS0 0RY  Lymphedema or an A&P System presentation TBC

Contact: Beverley on 01702 460890

JUNE 2018

2 Leeds Branch Meeting

9.30am for a 10.00am start at St Mary’s Social Club, Melton Street, Batley, West Yorkshire, WF17 8PT. Contact Caroline on 07583 934468 for further information.

7 Birmingham Branch Meeting

At Wallace House, Oat Street, Evesham, WR11 4PJ

Contact: Kate on 01789 262365 or email kathrynharrison87@gmail.com

10 Nottingham Branch Meeting

At Anthony Eaton & Associates, Feet & Co, 85 Melton Road, West Bridgford, Nottingham. NG2 6EN

Contact Valerie on 0115 931 3492

20 London Branch Meeting

19.30 at Ozzie Rizzo, 14 Hay Hill, Mayfair. W1J 8NR.

Contact: Sarah on 07790 717833 or email footwoman@gmail.com

JULY 2018

1 Cheshire, North Wales Branch Meeting

10.15am at the Dene Hotel, Hoole Road, Chester

Contact: Michelle on 01704 540614

2 North West Branch Meeting

7.00pm at St Joseph’s Parish Centre, Harpers Lane, Chorley. PR6 0HR Contact Alison on 01772 623180

8 Western Branch Meeting

At 12 noon – 3pm Liverpool Women’s Hospital

Contact Rachael on 07984 534264

19 Sheffield Branch Meeting

At 7.30pm at Heeley Sports and Social Club

Contact Helen on 07789 025022

SEPTEMBER 2018

16 Essex Branch Meeting

First Aid Course (tentative date) TBC

Contact: Beverley on 01702 460890

16 South Wales and Monmouth Branch Meeting

At 2pm until 4pm at Insole Court, Fairwater Road, Llandaff, Cardiff. CF5 2LN

Contact Esther on 01656 740772

24 North West Branch Meeting

7.00pm at St Joseph’s Parish Centre, Harpers Lane, Chorley PR6 0HR Contact Alison on 01772 623180 for further information

26

London Branch Meeting

19.30 at Ozzie Rizzo, 14 Hay Hill, Mayfair. W1J 8NR.

Contact: Sarah on 07790 717833 or email footwoman@gmail.com

OCTOBER 2018

7

Cheshire, North Wales Branch Meeting

10.15am at the Dene Hotel, Hoole Road, Chester

Contact: Michelle on 01704 540614

14 Western Branch Meeting

At 12 noon – 3pm Liverpool Women’s Hospital

Contact Rachael on 07984 534264

18 Sheffield Branch Meeting

At 7.30pm at Heeley Sports and Social Club

Contact Helen on 07789 025022 for further information

NOVEMBER 2018

18 Essex Branch Meeting

2pm at the Southend University Trust Hospital Education Centre Carlingford Drive, Southend-onSea, Essex SS0 0RY  TBC

Contact: Beverley on 01702 460890

18

South Wales and Monmouth Branch Meeting

2pm until 4pm at Insole Court, Fairwater Road, Llandaff, Cardiff CF5 2LN

Contact Esther on 01656 740772

28 London Branch Meeting

19.30 at Ozzie Rizzo, 14 Hay Hill, Mayfair. W1J 8NR.

Contact: Sarah on 07790 717833 or email footwoman@gmail.com

JANUARY 2019

10 Birmingham Branch Meeting

At Wallace House, Oat Street, Evesham WR11 4PJ

Contact: Kate on 01789 262365 or email kathrynharrison87@ gmail.com

13

Western Branch Meeting and AGM

At 12 noon – 3pm Liverpool Women’s Hospital

Contact Rachael on 07984 534264

14 North West Branch

Meeting and AGM

7.00pm at St Joseph’s Parish Centre, Harpers Lane, Chorley. PR6 0HR Contact Alison on 01772 623180

16 London Branch Meeting

19.30 at Ozzie Rizzo, 14 Hay Hill, Mayfair. W1J 8NR.

Contact: Sarah on 07790 717833 or email footwoman@gmail.com

20

Nottingham Branch Meeting

Anthony Eaton & Associates, Feet & Co, 85 Melton Road, West Bridgford, Nottingham. NG2 6EN Contact Valerie on 0115 931 3492 for further information