Podiatry Review July/August 2010

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July/August 2010 Vol. 67 No. 4 ISSN 1756-3291

The Myths of Podiatric Biomechanics What do we mean by Normal Volunteering in Rural China A.G.M. Postbag

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Contacts Editor: Mr. R. H. S. Henry Email: editor@iocp.org.uk Editorial Assistant: Mrs. B. K. Willey Email: bernie@iocp.org.uk Published by: The Institute of Chiropodists and Podiatrists 27 Wright Street, Southport, Merseyside PR9 0TL Telephone: 01704 546141 or 08700 110305 Fax: 01704 500477 Email: secretary@iocp.org.uk Web: www.iocp.org.uk

Contents 1. Editorial 2. HPC News 3. Diabetes News 4. Article - The Myths of Podiatric Biomechanics 7. Personal Profile Michelle Taylor 8. Article - What do we mean by Normal Greg Quinn 10. Volunteering in Rural China, Tim Maiden 14. President’s Page 16. A.G.M. Postbag 22. Branch News 32. Achilles Hele 33. Classified Adverts 34. Diary of Events Annual Subscription: £25.00 Single Copy: £5.00 Including Postage & Packing ISSN 1756-3291

Dear Reader

Traditionally this issue of Podiatry Review is concerned with reporting on our A.G.M., lectures, trade show, and dinner dance held in Nottingham in May this year. What a get together it was! The highlight of the social occasion was the fancy dress, with the medieval theme of Robin Hood and his Merrie Men, Maid Marion, all her court followers and the Knights bold.

I went as ’Roger the Lion Heart’.

To be serious we thank all those people who gave lectures and workshops:Professor Wesley Vernon OBE, Greg Quinn FCPodS P, Maureen O Donnell BSc(Hons), Dr. Menos Lagopoulos MD PhD, Robert Isaacs, BSc(Hons) MChS Cert. KCHyp We thank:

– Judith Barbaro-Brown MSc, PGDip,BSc(Hons), BA(Hon),PGCE, for her after dinner speech which was well received.

July/August 2010

– Hans Bakker from Canonbury Products very kindly sponsored The Presidents Reception and our appreciation goes to him.

– Crocs Rx and DLT sponsored the A.G.M. folders and very professional they looked too. We thank Crocs Rx and Darren Sandy of DLT for once more coming to help us.

Thank you Darren Sandy for your kind gesture.

– Stephen Gardner and his team from Nottingham for producing an excellent conference with the right balance between the lectures, workshops and the fun items, the medieval fancy dress and the dinner dance.

We also thank Jill, Bernie, Julie and Sarah, the ladies in the office, for all their hard work.

I look forward to the Windsor Conference in 2011.

Roger Henry, Editor Podiatry Review

© The Editor and The Institute of Chiropodists and Podiatrists accept no responsibility for any opinions expressed in the articles published in the Journal; and they do not accept responsibility for any discrepancies in the information published. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise, without the prior written permission of the Publishers.

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Stay on the Register

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News News News News News News

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here are several ways to make sure your name stays on the HPC Register.

Log on to the online system now to update your contact details. Alternatively, you can call the HPC Registration Department to update your details.

●

Renew your registration online, or send your renewal form (and payment) to HPC well before the deadline.

●

Help your colleagues to stay registered by reminding them about renewing their registration and telling them about the online system.

●

If you would like free renewal posters to display in your workplace, please email publications@hpc-uk.org or call the Communications Department on +44(0) 20 7840 9806.

Promoting your HPC registration

HPC have recently launched an HPC registration logo, which can be displayed by registrants as a clear sign they meet their standards. Developed using feedback from

registrants and members of the public, the logo is designed to be simple, bold and easily recognisable. It replaces the ‘Advert e-kit’ and the HP Check logo, and can be used on stationery, marketing materials, signage, websites, and vehicle livery. Use of the logo is subject to terms and conditions which must be agreed to when downloading the logo from the HPC’s website, and for this reason the logo can not be obtained in any other way. Along with the new registrant logo, they have also created a leaflet called ‘Promoting your HPC registration’, which brings together information about the range of materials available to help you promote your registration with the HPC. These include free public information posters and leaflets which are designed to be displayed in public areas.

If you are using the HP Check logo, please replace it with the new HPC registration logo when you next update your printed materials, and amend any online information as soon as possible. For more information, and to download the new HPC registration logo or order free public information materials, see www.hpc-uk.org/registrants/promoting.

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Working overtime is bad for your health

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eople who work three or four hours overtime a day increase their risk of heart disease by 60 per cent, according to a new study published in the ‘British Heart Journal’.

Doctors found nearly 370 cases where people had fatal heart disease, a heart attack or developed angina. These cases seemed to be strongly linked with the number of hours spent working overtime.

Less time to exercise, relax and unwind

Researchers suggest one explanation for this link may be that people who spend more time at work have less time to exercise, relax and unwind. They may also be more stressed, anxious, or depressed.

However lead researcher Mianna Virtanen stressed that ‘more research is needed before we can be confident that overtime work would cause coronary heart disease’.

Society’s Poorest more likely to be obese

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report published in the ‘European Health Journal’ found that the poorest in society were most likely to be obese.

The findings contradict the common perception of poverty illustrated by a famished young child and of obese people as self-indulgent and lazy.

In countries such as Ethiopia, the cheapest foods are the least calorific and so the poor systematically lack access to energy-rich foods, and have a higher chance of malnourishment and starvation.

By contrast, in Britain the cheapest foods are the most caloriedense so the poor here are more at risk from obesity.

Limited food choices promoting unhealthy lifestyles

Additionally, in the more deprived areas of Britain there are fewer outlets offering healthy foods, and healthier food is more expensive in these areas than in less deprived areas. This fundamentally limits the food choices that poor people can make, thereby promoting unhealthy lifestyles, and, ultimately, obesity.

The article also argued that obesity often occurs in people from less wealthy backgrounds because of ‘food insecurity’, or a lack of regular, dependable access to food. Not knowing where or when their next meal is going to come from, many poorer people will over-consume food when it is available. This can become a cycle of over-consumption based on insecurity which can ultimately lead to obesity.

“The decisions the poorer in our society are forced to make when it comes to choosing what food to eat need addressing urgently if we are to curb the growing obesity and associated Type 2 diabetes epidemic that currently exists in the UK”, Cathy Moulton, Diabetes UK Care Advisor, said:

“We need to challenge the public’s attitude towards overweight and obese people, and give equal attention to both the individual’s responsibilities and the responsibilities of political and business leaders.”

Diabetes UK encourages people to get active at work to improve their health by keeping fit and lowering their stress levels.

“Physical activity benefits weight management which in turn reduces a person’s chance of developing Type 2 diabetes as well as lowering the risk of a heart attack or stroke”, said Diabetes UK Care Advisor Cathy Moulton.

Keeping active can improve diabetes control

For people with diabetes, keeping active can improve diabetes control and help prevent some of the complications of diabetes”, she added:

“There are some simple ways of looking after your health at work: you can take the stairs instead of the lift, go and speak to a colleague in person instead of over the phone, take a brisk walk at lunch time, and snack on fruit rather than biscuits.”

The Journal of the Royal Society of Medicine Vol.103 No. 4

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arries an interesting article on Diabetes Management and Guidelines during Ramadan. Diabetes affects 22% of Pakistani and 27% of Bangladeshi Muslim population (aged 25 to 74 years). There are approximately 325,000 Muslims in the UK suffering from diabetes. Fasting during Ramadan is an integral part of the Muslim faith and takes place during the ninth month of the Islamic calendar and is obligatory upon each sane, responsible and healthy Muslim. Certain categories of people are exempt from fasting including those with chronic illnesses where fasting might be detrimental to their health. An international consensus meeting of healthcare professionals and researchers with an interest in diabetes and Ramadan was held in Morocco in 1995 to establish guidelines concerning patients who should be exempt from fasting. It was determined that these should include those suffering from type 1 diabetes, type 2 diabetes with unstable disease, diabetes with complications, pregnant women with diabetes, elderly patients with diabetes. Those who were stable should be allowed to fast even if they were prescribed medications such as biguanides and sulfonylurea. A major study (EPIDIAR Diabetes Care 2004;27:2306-11) reported no change in the body weight during Ramadan, but there is an increased risk of severe hyperglycaemia and ketoacidosis. Also at risk of increase was severe hypoglycaemia. Retinal vein occlusion was apparently increased with 29.5% of attacks taking place during Ramadan. However, it should be noted that this study took place in Saudi Arabia and the authors suggest that dehydration might have been responsible. Although the studies did not mention an increase in peripheral vascular problems, nor any neurological defect in the feet, healthcare professionals should be aware that 43% of patients with known type 1 diabetes and 79% with type 2 diabetes fasted, and as is well known, the suspected cases of diabetes are much higher than those that are proven.

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Myths of Podiatric Biomechanics A

Robert Isaacs BSc(Hons)MChS Cert. KCHyp

s a wise man once said, “many of the truths we cling to depend greatly on our point of view.”

Biomechanics is a wonderfully challenging specialism for the clinician and theorist alike. In the last 39 years since Root, Orien and Weed published their model of biomechanical assessment and prescription the science has made great strides, mostly in the wrong directions (though a few in the right ones).

Biomechanics is as a great stew in which we fish for the meat of knowledge and the potato of clinical effectiveness amidst the oily film of bias, the unidentifiable wobbly bits of myth and the indigestible gristle of presumptions. And we must be ever alert for the cockroach of deliberate, profit driven error which can all too often scuttle in unregarded.

If you will, dear reader, follow me now through some of the pieces which have the superficial appearance of wholesomeness, but which in truth may well cause you a day on the metaphorical lavatory if you swallow them.

Myth 1 The foot should function/functions best in sub talar neutral This one is born of a misinterpretation of Root’s original work. Root never actually stated that the foot should be in Sub Talar Neutral throughout gait. Sheldon Langer, in his book “A practical manual for a basic approach to foot biomechanics” states that: “In the ideal person, when the subtalar joint is in neutral position, a line bisecting the posterior aspect of the calcaneus will be vertical… This is true both on and off weight bearing”1.

This is neither clinically reproducible, nor logically consistent. Firstly, as Langer’s book states elsewhere, pronation is a necessary movement to absorb shock. If the foot is “held” in sub talar neutral it cannot fulfil this essential function.

Secondly, for the foot to be in sub talar neutral in relaxed stance the body must expend considerable muscular effort. Try it yourself, it’s tiring! It is not logical for the position of rest to demand so much of the body.

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Thirdly we have copious dynamic data which shows that the sub talar joint in a normal, healthy individual works through a pretty broad range during gait.2 It certainly does not stay in a single position, why should it? What would be the point of having a joint which does not move?

Myth 2 Insoles hold the foot in sub talar neutral This one is born partly of a desire to fit in with myth 1.

There exists still the quaint notion that if you cast the foot in a certain position, that the insole will hold the foot in that same position. That would be true if the insole was screwed directly to the bones of the foot, however almost no orthotics have this feature.

Studies show us that there is considerable variation in the effect of orthotics on rear foot position3. There has NEVER been a study which showed a 1:1 ratio, that is that a 5 degree heel wedge will incline the foot by 5 degrees. There is just too much “slop” of the foot on top of the orthotic.

Unless it wraps around the foot or ankle (like a SMAFO or some UCBLs) or unless it has the aforementioned screws, orthotics cannot “hold” anything. They can push, but that’s all.

Myth 3 Pronation is bad This is another frequent misquote of Rootian Biomechanics. Pronation is a rather useful and vital movement. It allows for adaptation to terrain. It allows for shock absorbtion. It allows for “smoothing” of motion over the stance leg so that there is less bobbing up and down. If you see a patient who has no pronation during gait, worry! They are probably in all kinds of trouble.

And yet, when you stand a patient with a pain in front of a medic, a physio, even a podiatrist, they will almost certainly nod owlishly and say something along the lines of “Egad, you’re pronating. That’ll be the problem right there.”

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Pronation is much maligned. Think of it as the shock absorber of the foot (in the same way as the shock absorber of a car) and you’d not be far from the truth.

Sometimes of course, the structures involved in controlling / decelerating pronation can become pathological. The plantar fascia, the tibialis muscles, the deltoid ligaments, the sinus tarsi are all susceptible to damage. But the fact that the structures can be damaged does not mean the function which caused the damage is a bad thing. An orthopaedic surgeon faced with an arthritic knee will not declare that it was caused by the knee bending and fuse it. A podiatric surgeon faced with a 1st met which has become painful would not state it was because the big toe should never bend. A mechanic faced with wobbly shock absorbers would not roll his eyes and declare that the function the shock absorbers were carrying out (before they broke) was abnormal or a design flaw. So why should we, when faced with a foot in which a structure involved with pronation has started hurting, say that it’s because pronation is a bad thing?

Pronation is a good thing! Cut it some slack!

Myth 4 Aha, but OVER pronation is bad Ok, so what is OVERpronation. Is it pronation beyond a certain point? At a certain speed? At an incorrect time during the gait cycle? Is it to do with degree? Stiffness?

Axial location? Residual moment?

It could be any of those things. But let’s be honest, we have NO evidence to show us where all those “certain points” lie. No consensus either, peoples idea for the “correct” position for an orthotic to operate range from almost flat to as supinated as the foot can achieve (MASS position). And in the absence of evidence that’s ALL they are, opinions.

Consider the typical Afro-Caribbean foot. Almost without exception they are much floppier than European feet and will sit in a much more pronated position in relaxed stance. Are they, to a one, overpronated? The disproportionate representation of Afro Caribbeans in elite running (especially in sprint races) would seem to suggest that the generally more pronated foot posture does not necessarily equate to poorer or less efficient function.

Like most joints there IS a range at which the joints sublux and become less efficient or pathological. This, I suppose, could be loosely termed as overpronation. But let’s be honest the majority of people given this label are not in that range.

In my experience the thing which leads people to be classed as “overpronating” is very simply, that they have a pathology. Which is a wonderful piece of circular logic.

Why do we say they are pronating too much? Because they have a pathology. Why do we think the pathology is

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there, because they are overpronating. And did we say they were overpronating? Because they have a pathology, etc ad infinitum.

This logical error is called “tautology”. It occurs when we make two statements which we consider to be true but which rest only upon one another. Why do I think the animal is a cat? Because it has a tail. How do I know it has a tail? Because ALL cats have tails.

Myth 5 There is no evidence that Orthotics actually work

Funny one this, no idea where it came from. There’s plenty! One should, I suppose, define what we mean by “work”. One could mean either have a measurable effect on the function of the foot or whether they resolve symptoms.

For the former contention many studies have shown changes in joint positions (kinematic) or in forces (kinetic) with the use of orthotics. The latter contention is harder to test as one must always consider the placebo effect. However Blake and Denton (1985)4 surveyed a population of patients and found that 70% of them opined that their devices “defiantly helped”. Donatelli et al (1988)5 surveyed a population and found that 91% were “satisfied” with their orthoses. Mororas & Hodge (1993) 6 surveyed 523 patients and found that 63% had their symptoms completely resolved and 95% at least partially resolved by their orthotics. There is a substantial body of evidence that orthotics can work!

So there we go. A few things floating in the saucepan which on close inspection are somewhat unsavoury.

Unfortunately it is rather easier to identify the obvious fallacies than the indisputable truths. Perhaps another day we shall dip another ladle into the stew and see if we can find some of those.

1. S. Langer and J. Wernick. A practical manual for a basic approach to foot biomechanics. 3rd ed., Langer Biomechanics Group (U.K.) Ltd. (1989).

2. MCPOIL T, CORNWALL MW: Relationship between neutral subtalar joint position and pattern of rear foot motion during walking. Foot Ankle 15: 141, 1994.

3. Blake RL, Ferguson HJ: Effect of extrinsic rearfoot posts on rearfoot position J Am Podiatr Med Assoc 1993 83: 447-456.

4. Blake RL, Denton JA. (1985) Functional Foot Orthoses for Athletic Injuries: A Retrospective Study. Journal of the American Podiatric Medical Association 75(7): 359-362.

5. Donatelli R, Hurlbert C, Conaway D, St. Pierre R. (1988) Biomechanical Foot Orthotics: A Retrospective Study. The Journal of Orthopaedic and Sports Physical Therapy 10(6): 205-212.

6. Moraros J, Hodge W. (1993) Orthotic Survey: Preliminary Results. Journal of the American Podiatric Medical Association 83(3): 139-148.

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Personal Profile Michelle Taylor

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BSc., M.Inst.Ch.P

fter nearly twenty years in practice with seven of them on a self employed basis. I thought it was about time I did my BSc, as this was something I had wanted to do for a number of years. I feel this is the way forward for the profession as a whole.

With encouragement from Malcolm Holmes I applied to New College Durham to start the BSc. A chance conversation with Loreto Sime at a branch meeting revealed that we were both enrolled to start at New College Durham in January 2009.

During the course of Year One, Loreto and I met up on a fairly regular basis, to go over course work and discuss what on earth were we doing!

Stuart kept us going with huge quantities of coffee, great lunches and he allowed us to pick his brains especially if I turned up with cream cakes!

The degree course is split into two years. Year 1 consists of three mandatory modules, two of which are research modules and the other statistics module. Along with three elected modules which for me were sports injuries and biomechanics, microbiology and pod gerontology.

No one knows what the future holds but obtaining a degree and higher qualifications in podiatry is the way forward. Therefore grab the future while you can, you just might regret not obtaining your degree.

Stuart, Loreto’s husband, was nominated as our chauffeur/driver for our induction week at Durham. Little did he know what he or even we were letting ourselves us in for! For those that know both Loreto and myself, they might have a lot of sympathy for Stuart – but secretly I think he enjoyed the abuse we gave him.

I would like to say thank you to Malcolm and Sue for proof reading, nit picking – and making sense of my assignments for me. As those who have done the BSc will know you can’t always see the woods for the trees. Thank you to Stuart and Loreto for the brain storming sessions and especially Stuart; it must have been difficult for him putting up with two females tormenting him.

The Institute of Chiropodists and Podiatrists Training Centre, Sheffield

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Following on from Greg Quinn’s presentation at the Institute’s annual A.G.M. in May, he promised to outline the subject of Epigenetics over a number of articles. The articles to be covered are: 1. What do we mean by ‘Normal’?

2. Evolution of the Human Foot.

2. The Epigenetic regulation of development.

3. What is meant by Ideal Foot Function?

4. Variable Traits of the Foot.

5. How do orthoses work?

Part 1 What do we mean by ‘Normal’?

Greg Quinn FCPodS Podiatric Surgeon

‘It is not usually a case of having a disorder or not – there is quantitative variation and there is a continuum.’ Robert Plomin

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he ability to distinguish between normal and abnormal feet is a fundamental requirement for each of us and our profession as a whole. This is because it plays a crucial role in deciding upon explanations for the signs and symptoms that our patients present with every day. It allows us to understand a course of events that lead to the development of a symptom and how to offset this with a restorative treatment. Linking the concepts of cause and effect lie at the heart of etiology; yet how are we to recognise abnormality in the foot’s structure that would account for the problems that the patient reports? Simple observable characteristics must be measurable and reliable and still be sensitive to the fact that all diagnostic tests take account of individual differences.

Number of Podiatrists

Height of Podiatrist

Yet in order to make sense of what we regard as a ‘normal’ foot we must have a specific interpretation of the term in mind. Normality itself can be understood in three broad ways: 1. Normality can be understood as a statistical concept, with an average measure of a range of values available to us. Other measured values can then be compared against this within a population. E.g. Height of the population, which will show a ‘normal distribution’ (bell-shaped curve), (see figure 1). Normality in this sense will have a precise definition and, as a mathematical function is the simplest and clearest understanding available to us. Many physical attributes of the foot can be measured reliably to offer average values but not being average does not imply being abnormal. E.g. we often describe the arch of the foot as being low, ‘normal’ or high. This is not a valid statement. Statistically the longitudinal arch angle is characterised by the terms low, medium or high and this reflects a full spectrum of values from 90-180 degrees.

That is to say, all feet within this range are normal and the average value is likely to be described as medium.

Figure 1. Statistical averages can help to define a range of normal values.

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2. The second way of understanding normality is as an evaluative concept. In this case a clinical procedure may have been carried out normally with no adverse incidents but the procedure itself may not be typical. E.g. removal of callus with a pair of scissors. Clearly, a definition based around what might or might not be conventional or culturally normal is not scientifically appropriate here.

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3. The third way of understanding normality is as a biological concept e.g. a normal foot, a normal environment or a normal response. A more specific appreciation of this notion occurs when we consider function. Consider the statement ‘The function of the foot is to provide pain free support during movement’.

This is clearly not about any particular foot and nor is it a statement about all feet, since clearly some feet fail to achieve this. It is also not about most feet or the statistically average foot. Suppose a foot required an orthosis for this specific purpose. This would not undermine the statement about the foot’s function.

Finally, the statement is not about the ideal foot. Why limit the ideal foot to supporting the body? The statement is about the biologically normal foot, with the understanding that a particular foot or all feet or most feet or the average foot or indeed the ideal foot may not be biologically normal.

The concept of biological normality is linked to a distinction between function and malfunction. To illustrate the point, a malfunctioning foot is an abnormal foot i.e. one distinction indicates the other. However, the term, an abnormal foot can be understood in several ways: It can be understood to mean a foot of abnormal structure or a foot that is responding abnormally. Yet a foot can be abnormal in one way without necessarily being abnormal in another, despite a sometimes obvious clinical link. It might therefore be argued that a malfunctioning foot is an abnormally behaving foot. This

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suggests that claims about normality are definable in terms of biological function.

In order to explain the etiology of foot problems, perhaps a more relevant term for us to consider would be the biological purpose of the foot within the context of movement. The central idea here would be to view the function of the foot as the particular effect or consequence which explains why it is there. That is to say, the function of the foot is to support the body during movement because the foot’s ability to support the body is the reason it is there!

The explanation for the acquisition of the unique structure of the human foot will be explored in a further paper, as will the interactive characteristics or traits that serve to explain its function. The discipline of podiatric biomechanics has all too frequently focused attention upon an ideal positioning of the foot to restore ‘normal’ function.

The natural variation in structure of the foot (above) is required to support body weight through the exploitation of several key physical attributes that deliver a common biological purpose i.e. movement. This enterprise requires the interaction of several internal and external forces.

Whatever the foot’s individual configuration, coping with such forces to deliver an ultimate purpose is what defines its ability to function normally.

Greg Quinn, Sheffield gregquinn.podsurgeon@googlemail.com

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Volunteering in Rural China Tim Maiden, Podiatry Student Cosyfeet Podiatry Award winner, Tim Maiden, was awarded £500 to assist with his voluntary work in rural China. He reports here on his experiences.

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he two central reasons for me becoming a podiatrist were to have the freedom to travel, and to help improve the quality of people’s lives. After reading about the adventures of previous winners of the Cosyfeet competition, I was determined to embark on a similar trip. I decided I wanted to undertake some voluntary work abroad after graduating from Cardiff University and before commencing employment for the NHS as a podiatrist.

I heard about many of the problems faced by sufferers of Leprosy in the world, and decided to spend three months offering help to those with resulting podiatry problems. China has always been a place of huge mystery to me, and following in-depth conversations with a friend who lives there, I made the decision that this was to be my destination. I’d heard of several worthwhile organisations working to alleviate the problems of rural poverty in China, and decided to make contact with them.

My visit began in the city of Shanghai, where I stayed initially, visiting some of the prestigious teaching hospitals there. As I discovered, these state-of-the art hospitals provide fantastically advanced medical care for city dwellers. These hospitals are, however, many thousands of miles away from some of the poorest regions, where people also need medical care.

Following my stay in Shanghai, I took a two hour flight west to Sichuan. Here I met with several Non Governmental Organisations (NGOs) in the hope of discovering the 'real' China and helping out wherever my skills could be of use.

Thankfully I was greeted on landing by some friends, as the airport was a raging torrent of people and all signs were in Mandarin, making the entire proposition quite daunting. During our initial conversations, my friends emphasized that my enthusiastic ideals about getting instantly knee deep in the action, treating patients and observing, would take some time to come to fruition. Many rural areas were still unsafe following the horrific earthquake experienced the previous year. We couldn’t simply launch in without appropriate grass roots knowledge. Initially we spent time forging good relations with the local officials, with whom we were to work closely to ensure that those who required the most urgent assistance would receive it.

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Sichuan is one of the most beautiful places I have ever visited. It is surrounded by the Himalayas, bordering Tibet, and is known as the spice capital of China, boasting thousands of rich and tasty local dishes. The girls of Sichuan are known as the Spice girls, due to their fiery and passionate nature. The history of the area is fascinating and there are countless fascinating historical museums which highlight this.

Even though I was to be working with a group of established medical professionals, it proved important initially to convince the authorities of our credentials and our usefulness. There were some misconceptions about Leprosy, and a genuine concern that outsiders would contract the disease and thus potentially spread it further afield. It was an important part of our role to work towards increasing awareness about the disease, and to establish an atmosphere of mutual trust and respect. We also needed to explain clearly how visits could benefit the sufferers as there were concerns that villagers might be disturbed by our intervention, upsetting their everyday lives and routines with no benefit to them.

Cultural and language barriers frequently created problems for all those working directly with the people we were there to help.

Those in outlying villages often have a poor grasp of the national language (Mandarin) and are from very different cultures. This posed problems even for the interpreter. It is hard for Europeans to grasp that some countries, such as China, are so vast that the urban inhabitants may have little or no idea of life as it is lived in poor, remote areas, or of the difficulties faced.

Historically, as is the case in many parts of the world, lepers have been forced from their homes and forgotten in colonies. In China things are now changing. There is a dawning realization that things can be improved. Stigma, education, access and resource provision remain issues and there is much work still to do, but these problems are not insurmountable, as China's own response the Sichuan earthquake showed.

I spent a total of 3 months in China, with the majority in Sichuan. A great proportion of this time was spent meeting with village officials, discussing plans, best case scenarios and what we hoped to achieve by visiting those in need. This was often

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The first Leprosy village I visited was an eight hour walk from the nearest road and was deep in the mountains. The houses were scattered over a wide area. This was a challenging journey with a 20kg bag. We had been informed that some still more distant areas would be off limits due to concerns for our safety following the earthquake. Some of the houses we visited were shacks with outside toilets, partially due to the huge logistical issues of transporting the appropriate building materials to such a remote area. Despite the apparent hardship these people were experiencing, they did have livestock, crops and fresh water, and could therefore survive the challenging conditions.

done over dinner, with all officials present who would be affected by the decisions made. Ultimately the discussions were useful and resolutions reached, despite many perceived difficulties at the time.

The organisation with which I was working for the majority of my stay brought together a wide range of people with differing skills sets. The group I was part of consisted of a doctor, several nurses and a physiotherapist as well as a farmer, a builder, and myself. I have not named it in this article for fear of compromising the valuable work it undertakes in China, but this organisation sought to improve the overall quality of life of the people in the Leprosy villages by offering not only medical help but also the skills and infrastructure for these rural communities to thrive independently.

The government has been working to provide some villagers in the area with basic shelter, and has recently installed a water supply. This was no small challenge as the area is totally isolated for large parts of the year. Due to this, the people try as much as possible to be self reliant. Despite injuries causing total peripheral neuropathy, and resulting deformities of the limbs, they work together to run subsistence farms, growing rice and corn with the simplest of wooden hand held tools.

The officials are hoping to move all the villagers to the same area at the bottom of the valley and provide new housing. This would make it much easier to monitor the population and make more regular visits for medical treatment feasible. They are also planning to build a road, to facilitate access to schools and markets.

One of the problems faced by medical bodies is the people's lack of willingness to use Western medication, and their reliance upon traditional Chinese medicine. Chinese medicines are favoured as foreign writing and packaging is often seen as untrustworthy, and the taking of a pill is unusual for many of the people there, who are more accustomed to taking medicine as a solution. This presents quite a barrier to the effective use of the multi drug therapy now used to cure Leprosy.

Leprosy can ravage the body and leave its victims deformed. It is a disease that attacks the central nervous system, allowing it to impact nearly all areas of the body indirectly. It is typically transmitted in airborne moisture droplets produced by coughing, breathing, and sneezing, and is caused by the bacteria Mycobacterium leprae. Although first seen under the microscope by Dr Hansen in 1873, there is reference to the condition going back to before the dawn of Christianity. Prior

In my experience, the establishment of good relationships between people in China is essential before any work can be commenced. Ultimately it felt like a great honour to be accepted, and to be allowed to visit and work.

There is much valuable work being undertaken by Leprosy organisations and charities, including education about the disease. The stigma experienced by Leprosy sufferers is often brought about by fear and ignorance of the condition. I was surprised to learn that there are countless colonies throughout the world. China is larger than Europe and has approximately twice as many people, which highlights the potential difficulties that may arise.

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to the discovery that the disease was caused by bacteria, people had thought that it was hereditary, or even caused by sin. In many places people have developed misconceptions about the disease, contributing to the prevalent, highly negative image of lepers and Leprosy. China is working hard to eradicate these unhelpful perceptions.

At various times in history blood was believed to be an effective treatment, either as a beverage or as a bath. That of virgins or children was considered to be especially effective.

Removal of the ovaries or fallopian tubes in women, and vasectomy in men, was practiced in the United States for many years. Fortunately the effectiveness of modern drug therapies is now beginning to be better understood.

Once the Leprosy bacteria enters the body, it destroys the nerve endings, which leads to neuropathy. The neuropathy leads to the increased risk of enduring injuries since sufferers have no way of knowing that their tissues or bones are being damaged until severe damage has been caused. These injuries can lead to infection and other complicated conditions. Leprosy can also attack the mucous lining of the nose, causing it to collapse. Once the nerves behind the eye are destroyed, the victim loses ability to blink, causing their eyes to dry out.

Many of the sufferers, despite improvements in wound care, require surgery. I witnessed patients with gangrene, neuropathy, plantar ulcers and almost total blindness. With the benefit of greater experience and clinical skills I am sure I would have recognized more conditions among the patients I saw.

As in the NHS, limited time per patient was a frustration.

Frequently I had only a couple of minutes with each and all I was able to do was to clean and re-bandage. The villagers tried their best to describe their symptoms and pains, but understanding them was difficult, Mandarin was seldom their first language and it was difficult for our translator to understand them. The experience was still an amazing one though, and a real privilege. I had previously witnessed ulcers and a few serious conditions, but the experience I received in China has enhanced my skills and knowledge a great deal and I will bring this to my work in the NHS. Had I been better skilled I may have been able to make a more positive impact, but just being there with other professionals taught me so much, and really prompted me to open my eyes and see how useful it is for us to work with other professionals, especially when you are the person with the least knowledge.

Whilst in China I attempted to find more information about Leprosy on the Internet, but this was very difficult due to poor internet connectivity in many of the mountainous regions. This may be one reason why local medical workers and care homes understand so little about Leprosy and how to help sufferers.

Lack of education and training is also a significant factor.

Several times working with local doctors it was apparent that the frustration of working with non concordant patients was making motivation very difficult for them.

Thankfully we were accompanied on our visits by local officials for whom nothing was too much effort. We were treated as honoured guests in people's houses, and they would often prepare food for us, which was presented to us in ritual fashion and was always delicious.

While in China I saw many cases of Leprosy. Two in particular continue to stand out in my mind.

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One 60 year old gentleman exhibited moderate signs of Leprosy, with mild clawing of the digits and hair loss to the eyebrows. He experienced a lack of sensation in his extremities and had an enlarged ulna nerve, which is a common sign of leprosy. Several years previously his family had convinced him to return to his home village in order to resume work to support the family. After only one night at home he walked the 30 miles back to the Leprosy village as he could not bear the shame he had brought on his family. Neighbours and other villagers had apparently threatened to stop dealing with his family in food and other goods. Now Mr. A serves as one of the leaders in his Leprosy village in order to assist the local doctors in treating those inhabitants with more extreme conditions.

The other gentleman who interested me greatly was a 73-year old very friendly individual. Sadly for him, he was totally blind.

His hands and feet were clawed, resembling flippers, and he had no teeth or eyebrows. His left foot had been amputated; however there were no palpable pulses anywhere in his lower leg. The medial malleolus was totally exposed and gangrenous, and he experienced extreme pain at night. He broke down crying with gratitude when we redressed his ulcers. This made me realize that these patients, separated from their families and communities, are in at least as much need of basic human kindness as medical treatment.

We attempted to assist and educate the people in the Leprosy villages with basic care and treatment, and were careful to set realistic targets with regard to self maintenance. Advising them to use foreign supplies or to wash feet daily, for example, would likely end in failure. I am hoping to return in a month with other medical workers to assess the success of our advice.

We are also planning to adopt a more robust and far reaching education plan.

China is a remarkable country and visiting it was one of the most epic, eye opening experiences I have had in my life. I would thoroughly recommend it to anyone who is considering visiting or even for those who have not.

For those who are interested in finding out more about Leprosy there are a number of organisations which can provide useful information, such as LEPRA, the Nepal Leprosy Trust, the World Health Organisation and the Sisters of Calcutta, founded by Mother Theresa.

I would like to thank Dr Marina in Llandaff for her advice, generosity and getting me nice and healthy for the trip, Professor Ryan for the literature whilst I was there and everyone else who gave me valuable advice, plus Gareth Hicks at Baileys Instruments and Paul Lawless at Salford Insole.

I have teamed up with several other medical workers and we are preparing for a number of trips next year, some of which will be to Leprosy areas where we plan to assist in treatment and education. If anyone is interested, please feel free to contact me for more information.

Tim Maiden tim.maiden@gmail.com

If you have been inspired by Tim’s story and would like to find out more about the Cosyfeet Podiatry Award please email prof@cosyfeet.co.uk

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13

President’s Address

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55th Annual General Meeting, Nottingham Dear Fellows, Delegates and Members.

It is my pleasure to wish you a very warm welcome to the 55th Annual General Meeting of the Institute of Chiropodists and Podiatrists here in Nottingham.

Our web site, demonstrated at esident's Prize our last A.G.M. cipient of the Pr Bill Liggins re is fully operational and will be used increasingly as the medium for communication with members. The site will be the subject of a development program each year, remember that it is your web site for you to use and put forward your ideas for future developments.

We have established a relationship with the Royal Society of Medicine which will permit IOCP members to join the RSM. Details will be published in the Members Area of our web site soon.

Valerie Dunsworth receiving Life Membership for services to the Institue over 30 years

Our Minimum Standards and Decontamination document will be finalised shortly. This has been a significant project and the documents will also be available on the Members Area.

In its long history the I.O.C.P. has always spanned the whole profession, representing all who work in the profession. Recently we have seen changes as a direct result of the H.P.C., far from closing the profession, as envisaged, it has created a broader, multi-tiered profession from y Prize the unregulated rar Lite ham Bas ng eivi Catherine Waller rec Review, Roger Henry Foot Health from Editor of Podiatry

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Practitioner to the Podiatric Surgeon.

Between these two sits the “grand-parented” chiropodist/podiatrist who has been given the opportunity to continue to study to degree level while working.

Lady Mayor ar riving at Conf erence with President, Hea ther Bailey an d Chairman, Ro bert Beattie

It is a major cause of concern among those who carry the protected title that others are allowed to practice without regulation. This will change although the changes are slower materialising than we had been lead to believe. Pressure from the public and from professional bodies will cause this to happen. Self regulation is one way that the IOCP can bring about change by overseeing our own non-HPC members.

The City and Guilds Accredited course is being widely discussed both within and Long Service Award Roger Henry outside the IOCP. Before committing resources to the course, the democratic process of holding a ballot of all members took place, resulting in an overwhelming vote in favour of the course.

The first cohort started soon after the 2009 A.G.M., and the course has attracted considerable interest from other organisations which provide their own courses of lower or higher academic rigour. These organisations would like us to relinquish the ownership of the course.

This would allow any course provider to take it up and benefit from our work for themselves. The resources spent by us would then be lost. The human resources have been provided directly through the Board of Education and the

Loreto Sime and Michel le Taylor accepting the Annual Branch Award from the Chairman on behalf of Western Branch

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We welcome Kate France to the position of Administrator/ Coordinator in Sheffield.

The IOCP display stand that you see at this A.G.M. was devised by Kate and will be used in public for the first time at Kettering in June, promoting the IOCP to a wider audience.

finance provided by income from courses run by the IOCP.

odge

ard Norman H

Long Service Aw

There will always be a place for the Foot Health Practitioner in our multi-tiered profession, there is also a need for our City and Guilds Accredited course in both the private and public sectors, and it would be folly of us not to lead the way forward and fail to take benefit from the increase in membership and influence this will bring.

Education and CPD courses continue to Long Service Award An ne Rockley expand with new courses being run at our Training Centre and CPD events being held at Branches and Area Councils. I have been delighted to accept invitations to attend and have been pleased by the uniform high quality of the training. I also find it of great benefit to hear the views of members who do not always attend the A.G.M. bara Heaton

Long Service Award Bar

My thanks go to those Branch and Area Council officials who do so much to provide CPD on your behalf.

The second audit of the profession Stephen Willey receiving Life Membership by the HPC is imminent, this time 2.5% of us will be called. Help for those called is available on request from Head Office. The team at Southport is there to help answer your queries regarding any aspect of the IOCP and professional needs. It is there to be used, you do not need to wait until the ather McCance Long Service Award He A.G.M. to ask questions.

Long Service Award Jea

nnie Sadler

ne Bourgeois

Long Service Award Lyn

My congratulations go to those who have completed their degree in Podiatric Medicine, to those taking their Masters in Podiatric Surgery, to those who have completed the course in Local Anaesthesia, POMS and the innovative area of skin surgery.

ienne Jobber

Long Service Award Viv

To the National Officers, Executive Committee and co-opted members of the Executive Committee I give my most grateful thanks for the work they have done on our behalf in the past year.

Finally, my grateful thanks go to someone who for twelve years has served the membership with compassion and integrity, and is stepping down from the post of Chairman of the Board of Ethics. Many members owe him much and as “Agony Aunt� Stephen Willey will be a very hard act to follow!

These members continue to work within the profession while they also study to elevate their qualifications.

My thanks also go to the Secretariat; Jill, Bet, Julie and Sarah for their hard work and continual good humour, coping with the increased work load of the past year.

ACPU Award presented Stephen Gardiner

to

Heather Bailey

The Professional Photographs courtesy of David Wm. Arbon, dwa Photography sales@dwaphotography.co.uk www.dwphotography.co.uk Tel: 0115 849 2674

Long Service Award David Crew

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Postbag

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I recently attended the Saturday of our A.G.M./Conference at Nottingham and wanted to write to thank all involved in the organization of the event. All aspects of the venue were splendid.

I thought the trade show was very extensive but with a friendly informal atmosphere. I attended one of the workshops (Infection control) which was most interesting. I did feel that the workshops were an additional and worthwhile “extra” and certainly seemed popular.

The lectures on the Saturday were of high quality as always. The speakers were both interesting and informative.

One of the best things about the day was meeting with colleagues old and new. If you have never attended our conference, do not assume it is only for the committee members. It is for YOU, the practitioner.

Do consider it for the future.

Many thanks once again Suzanne Ostler, Sheffield Branch

Dear Editor, I am writing to express my thanks and appreciation to Stephen Gardiner and team at Nottingham for an excellent Conference this year. The quality of the lectures, the food and accommodation and helpful staff at Eastwood Hall made the weekend most enjoyable. The lecture given by Maureen O'Donnell Expert Witness and Medical Legal, made me think of how I can improve my records and I will be putting this into practice immediately.

Looking forward to the next A.G.M. in Windsor.

Denise Willis, Chester North Wales Staffordshire and Shropshire Branch

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Dear Editor, Having attended the Annual General Meeting, Conference and Dinner Dance for quite a few years, I keep thinking I must have experienced the ‘best’ but every year the organising branches manage to introduce some ‘originality’ which makes their A.G.M. successful, special and memorable. Well done Nottingham branch and the Midland Area Council - the medieval fancy dress on the Friday night was innovative, a perfect ‘ice breaker’ and brought hoots of laughter as the National Officers, Members and Traders alike appeared in their various guises. My boss, Mr. Beattie, spoke to me for several minutes before realising who I actually was!

The feedback from the lectures and workshops was excellent and the Saturday evening dinner and dance was thoroughly enjoyable.

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I cannot let this opportunity pass without thanking the credential officers; Heather McCance and Anne Rockley and scrutineers; Lynne Bourgeois and Anthony Eaton for doing a great job despite having me to advise them! Tony, I hope you have recovered.

I look forward to seeing you all at Windsor next year and hope even more of you will join us.

Bernie Hawthorn, Head Office

Dear Editor, A big thanks to the Nottingham branch, this years hosts for our A.G.M. & Conference. The weekend certainly kicked off with a difference with a medieval theme on the Friday evening. It was good to see so many enthusiastically taking part in fancy dress! The archery competition was not only great fun but raised funds for the charity, Help for Heroes.

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Also this year for the first time, we had a choice of workshops to attend. I enjoyed the Nail Surgery workshop

by Judith Barbaro-Brown - it was an excellent and most informative presentation.

It was nice to meet up again with friends and colleagues I'm already looking forward to Windsor in 2011.

Alisdair Reid, West of Scotland Branch Dear Editor, After so many A.G.M.’s I shouldn’t be surprised at any eventuality. Now I can’t honestly say that I’ve never been chucked out of anywhere, but I can say that Eastwood Hall in Nottingham is the first place where I haven’t even been allowed in!

I arrived in plenty time to set up our trade stand along with my wife Diane and Sammy, my eldest grandson. We stopped outside the main reception, I climbed out of the car and walked towards the entrance. As I looked enquiringly through the reflections on the plate glass doors I spotted two attendants dressed in Lincoln Green with green hats embellished with large pheasant feathers. They stood inside the door with right hands raised, palms outwards in that

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So congratulations from us to all of you who put yourselves out to make the whole thing a resounding success. Also thanks for choosing a venue with tiny squirrels, my camera has 34 pictures of the little varmints all taken by my grandson Sam.

STOP gesture that a traffic policemen would use. Stopping short I wondered why entry was barred - was I at the wrong place?

I re-read the word “Reception” on the door. Looking again I saw that the ‘attendants’ were doubled up with laughter. As they straightened up I recognised them as Heather McCance and Ann Rockley, Nottingham Branch members hosting the A.G.M. who were on door duty to welcome one and all. Their laughter was catching and they’d certainly had me fooled (that’s one I owe you two).

After setting out our station display, the weekend progressed in much the normal informal manner as previous years. A fair smattering of Robin Hood associated costumery was obvious all the time and on the night of the social event the place was stowed off with Robin Hoods, Maid Marions, Fat Bald Friars, Sheriffs and numerous other celebrities from history wandering about wearing rather attractive tights (John included). All of course in the best of taste.

The trade show was very well attended, the venue was very nice, and as usual well planned and as always it was the friendly welcoming event we have come to expect.

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We are, as always, looking forward to 2011 at Windsor, I believe.

Des Currie, Printer North East

Dear Sir, I would like to express my thanks and gratitude to everyone who was involved with the organisation of the 2010 A.G.M. and Conference held at Eastwood Hall, Nottingham.

Although only able to stay for the Friday and Saturday due to my holiday arrangements, the venue was superb. The accommodation and food were excellent, the trade show was of the good standard we have all come to expect and the lectures were fantastic.

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Continued ProfessionalDevelopment

The Institute of Chiropodists and Podiatrists

Continuing Professional Development This article is one of a series of educational documents that can be inserted into your portfolio and be a contribution towards your personal CPD learning.

The Role of the Pathology Laboratory in Podiatric Medicine Martin Harvey PGC BSc(Hons) MInstChP. Podiatrist Prescriber In many areas of medicine the role of the Pathology Laboratory is well recognised and it forms part of the multi-discipline framework that is now the rule rather than the exception in modern patient care. While some would argue that too much routine testing is carried in modern general medicine (Fowkes 1985) it is hard to imagine how many conditions within its remit could be specifically identified without the assistance given by a biomedical scientist using the increasingly sophisticated resources that modern laboratories have.

Examples that spring to mind include the microscopic examination of tissue removed from a pigmented lesion to determine whether it is a benign naevi or an aggressive malignant melanoma, or the assay of a blood sample to determine whether an enlarged prostate gland may be entirely benign or possibly cancerous.

In contrast to the above, it can perhaps be argued that Podiatry, especially in private practice, has yet to fully embrace the

concept of using tests on samples of tissue or body fluids. It is true that modern podiatry textbooks contain substantially more information on the subject of tests than they did formerly (Yates 2009) but without pathways that give independent access to test facilities and the knowledge and resources to appropriately collect the samples required for such tests, then such information is perhaps of more academic than practical worth.

In this short article the kind of routine tests that may be of value in podiatry will be briefly mentioned together with an introduction to the way in which a modern private pathology laboratory conducts such tests. Some of the following tests require specialist training to collect the samples discussed but such training is perhaps more widely available than may be realised, and is also in many cases available as brief courses from various providers. It is also to be hoped that specialist podiatry trainers will start providing such training as the profession continues to develop.

Table 1. Examples of tests relevant to primary and secondary podiatric medicine Type of Test

Sample Required

Method of Collection

Skin Fungus

Skin Tissue

Scrape skin with sterile blade into suitable container. i.e. a Dermapak® envelope

Nail Fungus

Nail Tissue

Bacterial infection

Swab of ? Infected area

Bacterial Arthritis

Joint fluid

Gout

Blood Sample

Figure 1. A collection of sample containers

Nail clippings put in sterile container

Use a sterile swab collection kit Vacuum blood collection tube

Aspirate joint and put fluid into sterile container An assortment of some of the containers used to collect and transport specimens. From left to right:

A sterile plain vial used for nail clippings and similar items not requiring a preservative.

Four blood collection ‘vacutainers’ – the colour coded tops indicate which tests they are indicated for, plus the type of needle and shroud used for them.

A sterile container containing a 4% formaldehyde solution for tissue samples intended for histopathology.

A sterile swab and its transport tube.

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Continued ProfessionalDevelopment Figure 2. A suitable site for taking a swab sample for subsequent culture (ŠM Harvey 2010)

This presentation actually turned out to be a necrotising vascultis which developed from an antigenic reaction to a hair dye. Perversely, it manifested in the legs and subsequently over a substantial area of the body.

Whilst prophylactic antibiotics (flucloxacillin 250mg QDS) were initially prescribed, they were proven to be not required in the long term, because no infection was actually present, as demonstrated by tissue biopsy, swab samples and culture.

In the absence of such investigations the patient could have been subjected to weeks of unnecessary medication and ineffective treatment.

Figure 3. A suitable site for taking a skin biopsy (ŠM Harvey 2010)

In this case the patient had a history of squamous cell carcinoma (SCC) in the area of the proximal nail fold on the second finger of the left hand.

Although the presentation of this left Hallux was consistent with onychocryptosis and a consequent pyogenic granuloma, the patient was convinced that this was also an SCC.

A punch biopsy (see black mark following haemostasis with AgNo3) plus a swab to identify the pathogen that had colonised the site, put the patients fears to rest. A subsequent routine partial nail avulsion and a course of flucloxacillin gave an early resolution to the case.

The Laboratory

Biomedical scientists are the professionals responsible for overseeing biomedical tests in laboratories and are, as with podiatrists, regulated by the Health Professions Council.

A typical Laboratory can provide hundreds of different types of tests, many of course which will be of little interest or relevance to podiatry. For example, it may be assumed that few podiatrists will routinely send in stool samples for faecal occult blood (FOB) testing or blood samples for liver function tests (LFTs). However, whilst the former example of FOB may hold true, in the case of an

LFT then that may be an entirely reasonable test to submit in the event that a podiatrist has prescribed an extended course of oral terbinafine or itraconazole. Both of the above drugs can be hepatotoxic in sensitive individuals or for those with a history of liver dysfunction due to disease or alcohol abuse. The types of tests that a biomedical laboratory performs may be cytological, i.e. on cells, or histological on tissue samples. Additionally tests are performed on body fluid samples such as articular fluid or on the waste products that various life processes produce. Chemical analysis is also naturally of use in identifying toxins or other products that may be hazardous.

Figure 4. The traditional image of biomedical science (ŠM Harvey 2010)

This picture of Steven Mulliner, the clinical director of Mullhaven Medical Laboratories Limited, shows a typical high-power microscope, which is still an important tool in performing visual examinations of items such as a film of blood smeared on a glass slide to check cell morphology (size and shape). Such an examination would be revealing in Sickle Cell Anaemia/Disease for example.

However, technology of a high order is now the norm in such laboratories, and whilst visual examination will continue to be of importance for the foreseeable future, the roles performed by automated analytical equipment will undoubtedly continue to evolve.

The automated machines that are now used, particularly in haematology, endocrinology and biochemistry, combine the features of analytical chemistry laboratories with powerful computers. Of particular importance in any laboratory is ensuring that specimens received are subjected to an effective audit regime to ensure they are correctly identified as belonging to a specific individual and that all through the procedures of whatever tests are required the specimens continue to be correctly identified.

One could picture for example the devastating results of mixing up two different specimens and subsequently suggesting that an individual had a fatal disease when such was not the case.

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The computerised elements of the analytical machines referred to above can be particularly useful in helping to ensure transparent traceability of specimens, the bar coding of specimens automatically by such machines is one example of this. Human oversight will undoubtedly continue to be necessary, if for no other reason than to counter our instinctive mistrust of entirely automated procedures but it is interesting to speculate how this will develop in the future as we become more at ease with the concept of entrusting more and more to increasingly reliable machines.

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Continued ProfessionalDevelopment Figure 5. An automated blood chemistry analyser (©M Harvey 2010)

This machine, costing in the region of £50,000, utilises the reaction between a blood sample and a reagent which is automatically introduced into the tube containing the blood that has been inserted in the machine.

A complex set of timed reactions gives a resultant "colour" (which may or may not be visible to the naked eye) but is analysed by photo-sensitive cells within the instrument and compared against a standard; the "colour" intensity is proportional (directly or indirectly) to the concentration of the analyte.

The machine automatically reads bar-code labels to identify the sample and also has a voice interface as well as a visual display identifying the progress of the test sequence being run.

Figures 6 and 7. Analysis tubes and reagent containers within the machine (©M Harvey 2010)

An area which still retains manual elements is that of ‘culturing’ specimens on sterile agar gel filled dishes that are then placed in an environmentally controlled cabinet for predetermined lengths of time, to see what develops in the medium surrounding the specimen.

Fungi and bacteria, if present, can proliferate in the favourable conditions offered by the agar gel and controlled environment and the nature and extent of the proliferation can be noted visually as spreading marks. Additionally, by incorporating areas within the culture medium that have been pre-treated with antibiotics or other

pharmaceuticals, then note can be taken of which agents are likely to be more effective against the infecting organism because this will also be visually apparent as any spread will avoid such areas.

This type of analysis is routinely used in determining whether a fungal organism is present, following initial microscopy that attempts to visually identify the presence, or otherwise, of fungal elements. It would also be appropriate as part of the review of skin squame samples sent for analysis.

Figure 8. Culture dish with labelled antibiotic ring (©M Harvey 2010)

An example of a pre-treated culture dish showing a ring of antibiotics against which the progress of the development of any organism would be measured.

The degree of progress would suggest which medications should be most effective against the pathogen (assuming there to be one) and also allow alternatives to employed either singly or in combination.

Such analysis can be used to inform clinical choices most effectively and if employed at early stages can prevent inappropriate treatment.

Apart from the culture processes referred to above, a manual process still used in the laboratory is that of preparing and staining samples for microscopic examination. The frequently used terms in bacterial identification of ‘Gram positive’ and ‘Gram negative’ refer to the propensity of certain groups of bacteria to absorb colour, or not, from the dyes originally developed by the Danish scientist Hans Christian Gram (1853–1938), who developed the technique in 1882 and published it in 1884. Gram used his procedure to discriminate between two types of bacteria with similar clinical symptoms: Streptococcus pneumoniae and Klebsiella pneumoniae bacteria. Further research identified the fact that other bacteria also fell into one or other of the groups and

in modern medicine, as each group respond to different types of antibiotics, such identification is important in making effective treatment decisions.

Staining is important in that it enhances the contrast of the microscopic image and allows a more precise identification and differentiation of the structures under examination.

There are now a wide variety of stains for different types of samples and purposes, many of which still bear the names of the chemists and researchers who developed them. Examples of such are; Ziehl-Neelsen stain, Masson's trichrome, Romanowsky stains and Conklin's staining (Penney 2002).

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Continued ProfessionalDevelopment Figures 9 and 10. Various stains and a stained microscope slide (ŠM Harvey 2010)

An area in which automation is being used to great effect in laboratories is haematology. It can be particularly valuable, for example, to know the cell count within a given volume of blood, be these red or white cells. Once a blood sample reaches the laboratory (sent by post or courier) then the sample tubes are agitated on rolling rods (figure 11) to ensure an even distribution of cells in the liquid plasma and then analysed by the machine shown in figure 12. Low red blood cell counts can indicate anaemia whilst high white cell counts can indicate current or past diseases of other types.

Figures 11 and 12. Evenly distributing cells in a blood tube and subsequent analysis (ŠM Harvey 2010)

Self Assessments Questions 1. What type of reaction caused the necrosing vascultis pictured?

2. Which part of the skin does SCC originate in?

3. Why is sickle cell anaemia so called?

Answers will appear in the September/October issue of Podiatry Review

Colleagues wishing to use the services of the private laboratory featured in this article, whose kind and patient help is most gratefully acknowledged, can visit www.mullhaven.co.uk for more information and details of the costs of various tests. Specimen containers and pre-printed forms are available from them and the laboratory director; Steven Mulliner can be contacted for advice on 01234 831115.

REFERENCES Fowkes FG. Containing the use of laboratory tests. BMJ. 1985;290:488 Penney DP, Powers JM, Frank M, Churukian C (2002) analysis and testing of Biological Stains - the Biological Stain Commission Procedures. Biotechnic & Histochemistry 77: 237-275.

Yates B (ed). Merrimans Assessment of the Lower Limb. Elsevier (3rd Edition). 2009: 366:385

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When I visited the Trade exhibition it seemed well attended with members updating their product knowledge.

The Friday night archery and fancy dress was a light hearted but welcome innovation though one or two of our distinguished gents enjoyed dressing up just a little too much (they know who they are), and the ‘Fun Boy Frankies’ rounded off Saturday night in style.

Overall then a great weekend which, as always leaves a lasting impression of belonging to a large professional body with all the advantage and support that offers.

Jon Ollivier, North East Branch The concurrent learning sessions were new and ran very well. It was the first time that we have had “hands on” lectures at our conference.

Over the years our conferences have grown in the amount of days and content and would only happen with such willing members in our Institute. I met colleagues old and new, it was lovely to see everyone, so if you didn’t manage to visit Nottingham this year, start organising your diary for next year as we are at Windsor.

Helen Lloyd, Western Branch Dear Roger, Just a short note to thank everyone who made the 55th A.G.M. a great success. It was an enjoyable and fruitful weekend from start to finish… good hotel/food, good lectures, good debate, good company. In fact I thought the CPD lectures were excellent this year and I understand from others who attended the workshops that they too were useful and relevant.

Dear All, I would first of all like to thank Nottingham Branch for another great A.G.M. As I said; last year- men in kilts, this year - men in tights… Heaven only knows what will be concocted for next year! And would you all kindly note I was dressed as ROBIN HOOD and not a garden gnome or a pixie!

On a serious note I would like to thank everyone for their good wishes and show of appreciation as I stepped down as Chairman of the Board of Ethics. I was totally overcome as I was awarded a Life Membership for service to the Institute and my 30 years membership certificate (although I still blame it on a draft from the window!!!) Thank you to my branch (Sheffield) for nominating me for this award. I am very thrilled and grateful to receive this award and I hope I have served you all well during my long term in office.

Finally, I would like to wish my successor, Mrs. Colette Johnston a long and happy term of office.

Stephen Willey, Outgoing Chairman, Board of Ethics

19

Vote of Thanks

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O

n behalf of Nottingham Branch, I would like to thank all who attended the 55th Annual General Meeting and Conference at Eastwood Hall on the 7th – 9th May 2010.

This year we saw a change in the usual programme with increased lecturers and workshops which many members attended.

It was also a pleasure to see so many taking part in the Friday night informal activities, entering into the spirit of donning medieval costume and taking up the bow and arrow with the archery competition. We hope the formal dinner-dance on Saturday evening was also enjoyable for all and our thanks to everyone who donated to the charities.

I am pleased to say that over the weekend a total of £ 1612 was raised. £ 923 for the Benevolent Fund and £ 678.20 Help For Heroes/Royal British Legion. A special thank you must also go to the President – Heather Bailey, who personally donated the cashprize for her envelope draw, which raised a large proportion of the donations. Thank you all for your support.

Nottingham Branch had worked extremely hard to provide members with an enjoyable conference and initial feedback suggests that you enjoyed the additional workshops and lecturers,

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with particular reference to the lecturers from Maureen O’Donnell which gave members a lot to think about and the revision lecture from Dr Menos.

Our thanks go not only to all of the lecturers and the trade houses in attendance for their support of The Institute and its membership, but all of the helpers who supported Nottingham Branch throughout the weekend.

We at Nottingham Branch, hope you enjoyed yourselves and have now had time to reflect on your learning for CPD.

On a personal note, I would like to thank the membership for comments received on a great conference; which along with the assisting members, the team at head office must also take much credit. I would also like to thanks those congratulating me on my new role as a National Officer – a role in which it is an honour to be elected and one in which I pledge to serve for the benefit of The Institute and its membership. I look forward to seeing you all soon.

Kindest Regards Stephen Gardiner, Conference Host 2010 Nottingham & IOCP Honorary Treasurer

2010 A.G.M. Organisers from Nottingham Branch 20

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2010 A.G.M. Trade Exhibitors Our thanks go to: AC Medical Advancis Medical A Algeos Ltd Bailey Instruments Ltd Barrier Healthcare Blue Zinc it Ltd Canonbury Healthcare Chiropody Express C & P Medical Trading Ltd Currie International Cuxson Gerrard DB Shoes Delcam Disposable Medical Instruments D L Townend, Son and Sandy Ltd Heeley Surgical Ltd Hilary Supplies Mobilis Rolyan Plinth 2000 Pro Fit Technologies Ltd Swann Morton Talar Made Ltd 21

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THE INSTITUTE OF CHIROPODISTS AND PODIATRISTS

NORTH WEST AREA COUNCIL 13 th A NN UA L S EM IN AR

On Sunday, 21st November 2010 PR O G RA M M E 9:00

Registration, coffee and biscuits.

9:25

Introduction.

9:30

Lecture- Part One: Dealing with Dementia.

10:30

Coffee and biscuits.

11:00

Lecture-Part Two: Dealing with Dementia

12:00

Cooked Lunch and Trade Stands.

2:00

Lecture- Lower Leg Oedema and Deep Vein Thrombosis.

3:00

Lecture- Greg Quinn

4:00

Prize Draw and CPD. Certificate issue and close of Seminar.

I f y o u p l a n t o a t t e n d t h e n p l e a s e c o m p l e t e th e B o o k i n g F o r m b e lo w a s so o n a s po ssib le , e n c lo s in g a ch e qu e fo r ÂŁ 6 5 : 0 0 ( t h is in c lu d e s lu n c h , t e a & c o f fe e ) , m a d e p a y a b le t o t h e I O C P N o r t h W e s t A r e a C o u n c i l a n d s e n d t h e m to : M r B r y a n M a s s e y , 1 0 4 , G illb e n t R o a d , C h e a d le H u lm e , C he s hir e , S K 8 6 N G .

T h e S e m i n a r i s o p e n t o C h i r o p o d i s t s f r o m a ll o r g a n i s a t i o n s a n d t h e y w ill b e m a d e v e r y w e lc o m e .

If y o u r e q u i r e m o r e d e t a i l s c a l l M a l c o l m H o l m e s o n , 0 1 9 2 5 6 0 2 1 8 1

Closing date for applications Saturday 13 th November 2010

Booking Form

NWAC 13th ANNUAL SEMINAR 2010

Name.........................................................................................

Address:....................................................................................................... Branch:-------------------------------..................................................................................................................

Postal Code: ............................

Tel No: ....................................

Email.................................................................................................

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Sheffield Branch Seminar

$4&00+&9-#:")(;#<&%')1*&,1#$%")1;#=9/># ?&&9&@#.',(#A"'-B#$4&00+&9-#$C#7D2

Sunday 17th October 2010 !"#$%&'(&)#$&*+,')#',-#./00&1#2/,34#5#678 !"#$%&'# ()*+),-,((,*)),,,,,,,,,,,,,,,,,,,,,,,,,,,.#/!0$1%$!2345266## ((*)),-,(7*,(8, ,9#:$;1#,

<=%1"%:2'2/> ?%1$!3,@%1A#>,?*B30$*5=*<*C,DE:,<2F,?#F, G.E?C,<H,5#1$

(7*(8,-,(+*(8, D;66#$,9;3:=,,,ID%1,JA%!'%&'#K (+*(8,-,(+*+),,,,,,,,,,,,,,,,,,,,,,,,,,,,,@##'#>,E;1/!:%',9$F (+*+),-,(L*+),,,,,9#:$;1#,

9>"M=2#F#"%, ?%1/%1#$,@%11!023C,EM#:!%'!0$,N;10#

These two exciting speakers will be sure to give us a very interesting and informative update on their chosen topics.

Present throughout the day

Heeley Surgical Ltd. â&#x20AC;&#x2DC;How to Revolutionise your thinking about working with single-use equipmentâ&#x20AC;&#x2122;

To Book a place Contact Debbie Straw (Secretary) Tel: 01623 452 711 Email: debbie.straw1@ntlworld.com

Please Book by 17th September 2010

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THE INSTITUTE OF CHIROPODISTS AND PODIATRISTS

Leicester and Northants Branch

Autumn Seminar 2010 Sunday 28th November 10:00 - 4:00p.m. at

Lutterworth Cricket Club, Coventry Road, Lutterworth

Dermatology Guest speaker

Ivan Bristow Msc, FCPodMed

Lecturer in Podiatry Faculty of Medicine, Health and Life sciences University of Southampton

Autoclave Service available by prior arrangement Trade support from Canonbury

Cost of day is ÂŁ80.00 Including lunch, refreshments and free parking Closing date for registration is 1st October 2010

Name .............................................................................................

Branch ..........................................................

Address..................................................................................................................................................................... .................................................................................................................................................................................. ..................................................................................................................................................................................

Tel .............................................................................

Dietary requirements ........................................................

Signature .......................................................................................

Date ..............................................................

Please make cheques payable to L&N Branch and send with booking form to: Mr. D. Ayres (Treasurer) Little Acre, Stemborough Lane, Leire, Leicestershire LE17 5EX Any other information please contact Sue Forster on email sue.IOCP@ntlworld.com

25

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pre- and post-flight. Measurable loading was recorded for only 30% of the time assigned for exercise. In-shoe forces during treadmill walking and running on the ISS were reduced by 25% and 46%, respectively, compared to similar activities on Earth. Mean on-orbit LE loads varied from 0.20 to 1.3 body weight (BW) during resistance exercise and were approximately 0.10 BW during bicycle ergometry.

Application of the EDLS model showed a mean decrease of 25% in the daily load experienced by the LE. BMD decreased by 0.71% and 0.83% per month during their missions in the femoral neck and lumbar spine, respectively. Our findings support the conclusion that the measured ISS exercise durations and/or loading were insufficient to provide the loading stimulus required to prevent bone loss.

Future trials with EDLS values closer to 100% of Earth values will offer a true test of exercise as a countermeasure to on-orbit bone loss."

RA

The ever interesting Podiatry Arena website has now extended their debate on barefoot running to no less than 15 pages. Some of the aficionados of running barefoot have become very extreme in their view that footwear of any kind should never be used when running marathons and other long distance races. Achilles - who prefers to pay younger and fitter individuals to do his running for him - feels that the unshod human foot has not adapted to flat, unyielding surfaces and therefore benefits from the addition of suitable footwear with appropriate orthoses in appropriate cases. A contrinutor from the USA reports that at a weekend presentation on gait, one of the audience members commented that going barefoot would cure all gait issues and further that going barefoot and using only the toes was the best way to store impact energy in the muscles and then release it to propel one forward. The commenter stated that "studies have shown" that the major purpose for several large muscle groups was energy storage for the rebound, and not energy generation. The presenter replied with "I wrote that study, and that is not what I said!" All the more reason for checking source material before making unsupported statements.

As the correspondent pointed out, actual energy storage is miniscule, but the idea of a free lunch seems to be quite seductive. A perpetual motion machine right there in our legs if only we take off our shoes!

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An additional experiment not directly associated with the above requires experimenters to tickle the feet of astronauts to assess possible neurological impairment.

MBLIN

The Medical Protection Society Casebook Vol.18 No.2 notes that a 45 year old male patient frequently attended at his GP practice and was anxious concerning his general health was badly affected by the death of his wife. He subsequently complained of pain in both hands and feet which he said were 'changing colour'. Every examination revealed nothing abnormal. The reported condition became worse, as did the patient's state of mind and he was referred to hospital. The physicians who subsequently saw him noted the possibility of Raynaud's phenomenon with acrocyanosis. The condition became worse and an arteriogram eventually led to a diagnosis of Beurger's disease. This case illustrates how important routine vascular checks can be, even in relatively young patients.

Assistive Technologies Issue 71 10. report that a new knee surgery technique has been developed which allows patients to return home earlier. Consultant Mr. Lee Longstaff at Spire Washington Hospital is using the technique to improve the accuracy of the operation, decreases the chance of misalignment and hence the long term prognosis. A computer is linked to a surgical infrared camera providing greater visualisation, tracking and monitoring of the position of the implant intra operatively. The technique is used in younger patients suffering from arthritides of the knee, and the patient can return home 3 days post-operatively. Return to work is possible in 6 weeks.

RO

It is good to report that in the same journal our old friend Greg Quinn of Talar Made is featured with a piece on foot morphology which is linked with his recent lecture at our A.G.M. In the submission he pointed out that the foot generally conforms to certain anatomical criteria in the 'normal' population. However, individual variations present with any number of variations within that norm. By noting a range of these phenotypes it might be possible to arrive at a consensus in planning and treatment and thus a more 'functional' as opposed to a 'structural' approach to foot biomechanics.

The same journal notes that humans are extremely good long distance runners and over Achilles Hele distances of tens of kilometres can outrun a horse. Bill Sellers of the University of Manchester has created a model of human hips and legs. The model was made to learn to run using trial and error and after thousands of attempts a life-like running motion developed. To see how important the elasticity in tendons are to gait, Sellers 'stiffened' the tendons by a factor of 100. The result was that energy use tripled and speed halved. He then restored normal elasticity to the Tendo Achilles only. "Even if the only tendon you have working is the Achilles Tendon, the model is capable of fairly competent running" said Sellers.

G

Do television series writers have a responsibility to the audience? The answer according to New Scientist 3rd April is definitely yes. Mathew Czarny, a medical student and bioethics researcher at John Hopkins University in Baltimore USA watched a total of 46 episodes of the medical 'soap' House. He found serious faults in the obtaining of consent, the provision of information and patient confidentiality. The show's doctors managed to fail 50% of the time. 58 instances of sexual misconduct between doctors and nurses and 27 between professionals and patients were also noted. The problem is, as Czarny sees it that patients will relate what they have seen on TV to the hospital that they are receiving treatment.

A DS

Cavanagh PR, Genc KO, Gopalakrishnan R, Kuklis MM, Maender CC, Rice AJ. In the Journal of Biomechanics 2010 May 10. [Epub ahead of print] report on â&#x20AC;&#x2DC;Foot forces during typical days on the international space station.â&#x20AC;&#x2122;

"The current study describes the loading environment of the lower extremity (LE) during typical days on the International Space Station (ISS) compared to similar data for the same individuals living on Earth. Data from in-shoe force measurements are also used as input to the enhanced daily load stimulus (EDLS) model to determine the mechanical "dose" experienced by the musculoskeletal system and to associate this dose with changes in BMD (Bone Mineral Density). Four male astronauts on approximately 6-month missions to the ISS participated in this study. Inshoe forces were recorded using capacitance-based insoles during entire typical working days both on Earth and onorbit. BMD estimates from the hip and spine regions were obtained from dual energy X-ray absorptiometry (DXA)

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Let’s Go Dutch Additionally I was invited to become Chairman of CAB, a role which I have now accepted. I am following in the footsteps of Gerard Mayne of Spenco Canada, a hard act to follow.

Annually FIP organize a “World Foot Health Awareness Month” This year’s special focus is on “Peripheral Arterial Disease”.

A conference of this stature obviously attracts top class speakers. From the UK we had amongst others Cathy Bowen,Trevor Prior, Ivan Bristow and Julian Livingstone. From the USA the outstanding Professor David Armstrong, specialist in Diabetic foot care and member of the Vasyli Think Tank. he 20th FIP World Congress of Podiatry took place from the 13th to 15th May in Amsterdam, the Netherlands and since I happen to be a native I thought I would share some thoughts with our friends at The Institute.

T

The international flavour makes this a very worthwhile event. Delegates were spoilt for choice with lectures, workshops and the trade exhibition with 56 exhibitors from across Europe and the USA was buzzing over the 3 days the event was held.

This event is held every 3 years and with FIP’s 28 member countries and an estimated 85,000 podiatrists it is an international gathering of increased importance. FIP attracted close to 1000 people in the RAI Exhibition Centre.

The outgoing FIP President, Robert Chelin DPM of Toronto is standing down after his 3 year’s tenure and Janet McInnes outgoing Chair of the Society, in the UK is taking over for at least the next 2 years.

FIP relies heavily on commercial sponsorship and for the last 10 years it has worked closely with its CORPORATE ADVISORY BOARD (CAB) where currently 11 companies make annual contributions to further foot health awareness worldwide.

I was pleased to see several Institute members.

Sharon Flint attended not only to learn about Podiatry but also to brush up on her Dutch. Maria Stevens and Belinda Longhurst also enjoyed their Dutch visit.

Canonbury Products has been one of the CAB members since the beginning. Clarks shoes, Algeos and Vasyli International are others familiar to the UK foot care market and co-members of the CAB.

The 2013 congress will be of much interest internationally. It looks like we are keeping this close to home as Spain, France and Germany are all keen to become the host.

Our reason for being there was primarily to meet with European distributors for both Vasyli and our specialist diabetic shoe range, Dr. Comfort.

I hope to see many of you there.

Hans Bakker, Canonbury Products Ltd

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1 5

CALLUS REDUCTION CREAM x Reduces callus by up to 50% 0% (avg 30%); x Cares for the skin with Willow Bark extract; x Works quickly and reliably; y x Contains salicylic acid and allantoin; x For soft smooth skin.

HYDROBALM x Increases skin moistu ure by more than 24%; x With 10% urea; a x Clear improvement in the skin structure; x With regular use dry skin areas are rehydrated and regenerated; x Good skin compatibility.

Hilary Supplies, 34A Halstead Road, Mountsorrel, Leics. LE12 7HF Tel: 0116 230 1900 Local rate 0845 3451678 Fax: 0116 230 3363 eM Mail: soniak@hilarysupplies. s co. o uk

28

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New Practical Skills: Learn the Art of Cosmetic Nail Reconstruction • !"#$%#" &'#( ) '* &'# ! +,- .'/ *+ 0)-#/ )! 12/0'!)-#" #3.!'4 5#!6 12/ -,# /#4-2/)- 2*( .2//#.- 2* )*" *2/0)! 4)- 2* 21 -,# -2#*) !47 • !" #$%& '( )%*&+ #, &%+%*&-" *./ 0*.1,*-!1& .2 %34%& %.-% . !"% , %5/ #, +).!"%! 0*!%& *5+ ,#& , .2%&.* 5 -#+0%! -+6 789 /%$%5#4%/ • 5/%:;%/ <1% !# =% * +14%&:%5*+! #.%:+!%4 0*!%& *56 >" -" */*4!+ !# !"% ,##!?+ 0#$%0%.!+@ • 5/%:;%/ <1%?+ */"%+ $% <1*5 ! %+ %.+1&% +%-1&% */"%+ #.6 %$%. !# -*55#1+%/ +A .@ • !"#$%#" &'# 4 "#)!!6 4' -#" -2 -,# 12!!28 *+ -/#)-0#*-4 ;&#!%-! .2 *./ +%*5 .2 !"% .* 5 =%/ 8&%*! .2 * 5%$%5 *./ .#&0*5 5##A .2 !#%.* 5 8#.-%*5 .2 / +-#5#1&%/ !#%.* 5+ B)-#! -6 !" -A%.%/ *./ !&*10*! +%/ !#%.* 5+ C%*5 .2 #, .2&#>. !#%.* 5 =&*-%+ !# !"% .* 5

Improve your patients self confidence: Create the nail they long for!

The Institute of Chiropodists and Podiatrists Training Centre, Sheffield On Sunday 25th July 2010 Full day seminar - £90 members and £110 non members Call 01704 546141 to book your place In order to attend the course you will need to purchase the LCN Pedique Starter kit, we have arranged a 15% discount

If in doubt… check it out!

ŽƵůĚ LJŽƵ ŵĂŬĞ ƚŚĞ ĚŝīĞƌĞŶĐĞ͍

As you may be aware there are a lot of scam and spoof emails/letters in circulation, far too many to mention and all with the same intent; to relieve the recipient of their cash!

Please be on your guard. If you are suspicious of any request for money or personal information DO NOT GIVE IT. If you are unsure as to the authenticity of any such communication please telephone Head Office on 01704 546141.

Unfortunately, we cannot stamp them out but we can do our best to ensure our Members do not fall victim.

Ž LJŽƵ ŚĂǀĞ ƉĂƟĞŶƚƐ ǁŚŽ ĐƌĂŵ ƚŚĞŝƌ ƐǁŽůůĞŶ ĨĞĞƚ ŝŶƚŽ ƵŶƐƵŝƚĂďůĞ ƐŚŽĞƐ͍ ŽƐLJĨĞĞƚ ĨŽŽƚǁĞĂƌ ŝƐ ŵĂĚĞ ĞƐƉĞĐŝĂůůLJ ǁŝĚĞ ĂŶĚ ĚĞĞƉ ƚŽ ŐŝǀĞ ĐŽŵĨŽƌƚ ĂŶĚ ƉƌŽƚĞĐƟŽŶ sŝƐŝƚ ǁǁǁ͘ĐŽƐLJĨĞĞƚ͘ĐŽŵͬƌĞǀŝĞǁĐŽƵůĚLJŽƵ ĨŽƌ Ă ĐŚĂŶĐĞ ƚŽ ǁŝŶ͘

3HUIHFW IRU VZROOHQ IHHW

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Institute Matters Dear All,

Firstly, I thank you for voting me in as Chairman of the Board of Ethics. I hope to serve you as diligently as Mr. Stephen Willey. This is just to let you know what the Board is up to.

Currently we only have three complaints in various stages. This is very good news. Please do not forget if you get a complaint either by telephone or in writing, inform Head Office (01704 546141) who will give guidance. Do not under any circumstances contact the complainant or their solicitors or anyone connected to them.

The main reason that complaints can proceed to court is due to incorrect recording keeping. Those who were at the A.G.M. and were lucky enough to hear the lecture given by Mrs. Maureen O’Donnell on "Expert Witness and Medical Legal" will know exactly what I am referring to.

Those who were not at the A.G.M. will very shortly be able to access that lecture via our website. I strongly urge all members to do this. Also good news is that within the next

Membership

Membership of the Institute of Chiropodists and Podiatrists is open to chiropodists/podiatrists registered with the Health Professions Council and Foot Health Practitioners who qualify for acceptance.

We offer professional and business support

To discuss further about becoming a Member or Associate of the Institute please call us and we would be happy to talk to you.

The Institute of Chiropodists and Podiatrists 27 Wright Street, Southport, Merseyside, PR9 0TL Telephone 01704 546141 email bernie@iocp.org.uk

30

couple of months a new issue of Minimum Standards of Clinical Practice will be ready to go on the website for every member to download. Again, I urge all members to read this document carefully.

Finally, registration is underway at the HPC and any members who have been called to audit, my advice to you is firstly do not panic, secondly act as soon as possible in getting the information back to the HPC and thirdly do not forget that advice is freely available from either Head Office or myself. I have no problems with any member phoning me for advice on any matter. If I can not help you I will put you in touch with someone who can.

Until the next issue, practice safely.

Colette Johnston Chairman of the Board of Ethics Telephone 07762 900 547 email: c.johnston1@virgin.net

Free Guide

A free guide to Fitting Socks & Hosiery for Swollen Feet is now available from Cosyfeet.

Written by Orthopaedic Footwear Consultant Gwenda Carter M.Ch. S M.S.S. F. it contains advice, tips and guidance for health professionals to pass on to patients.

The guide gives advice on how to ascertain whether a patient would benefit from specialised socks and hosiery, and details the best types to recommend to patients with diabetes, circulatory problems and general swelling. For those with reduced mobility, it also features products to assist with putting on socks, stockings and compression hosiery.

“A sock that is too small can be as uncomfortable and possibly as harmful as a shoe that is too small,” says Gwenda Carter.

“Patients with swelling can really benefit from socks and hosiery designed to meet their specific needs.”

For a free guide call Joy Clay at Cosyfeet on 01458 449071 or email prof@cosyfeet.co.uk

28902_Chirop_July/Aug_2010:17416_Chirop_Jan_Feb_08

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31

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Continuing Professional Development B OOKI NG FORM

Please send your booking, together with a cheque or completed Credit/Debit Card Form to:The Institute of Chiropodists and Podiatrists, 27 Wright Street, Southport, Merseyside PR8 0TL Telephone: 01704 546141 Fax: 01704 500477 Email: secretary@iocp.org.uk Website: www.iocp.org.uk PLEASE COMPLETE IN CAPITAL LETTERS Name: .....................................................................................................................................................................................

Address:...................................................................................................................................................................................... ...............................................................................................................................................

Tel No: ..............................................................................

Branch/Organisation:

Seminar/Workshop

Date

Postcode: .............................

............................................................

Venue

Cost

Cosmetic Nail Reconstruction Workshop

Sunday, 25th July 2010

Sheffield

Podiatric Dermatology

Saturday, 4th September 2010

Sheffield

Vascular & Neurological Assessment

Saturday, 16th October 2010

Sheffield

Cosmetic Nail Reconstruction Workshop

TBC October 2010

Sheffield

Verrucae Treatments

Saturday, 6th November 2010

Sheffield

Laser Therapy

Saturday, 4th December 2010

Sheffield

TOTAL

£

PAYMENT BY CREDIT CARD Please debit my VISA / MASTER CARD (Delete as applicable) with £............................................ as payment for the above.

Card Number: Expiry Date of Card:

........./.........

Security Number:

...................

Issue Number: (Switch/Maestro) ...........................

Cardholder’s Name:

.................................................................................................

Cardholder’s Signature:

...............................................................................................................................................................................

Cardholder’s Address:

...............................................................................................................................................................................

Initials: .................................................

.............................................................................................................................................................................................................................. .............................................................................................................................................................................................................................

32

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The Institute Strongly advises any applicants seeking employment to obtain a formal “Contract of Employment”

Chiropodist/Podiatrist Required

Sheffield, Chiropodist/Podiatrist

Required to join our busy friendly practice initially 2/3 days per week, with potential for more days. Clinic based.

Days hours to be discussed.

Self employed basis. Excellent clinical and interpersonal skills essential.

Biomechanics/surgical skills optional. Please contact: Sheffield Chiropody and Podiatry Centre on 01142 766 557 or email sheffield@iocp.org.uk GREENWICH - Chiropodist/Podiatrist. Develop a growing service inside a Pharmacy premises. Good Support staff.

Located near Healthcentre 1-2 days per week Telephone: 0208 469 1711 email: info@rosepharmacy.co.uk

Chiropody Supplies

BUSINESS CARDS printed 1 side: 1,000 = £40, 10,000 = £96.

Appointment Cards printed two sides: 10,000 = £99. Record Cards, Continuations, Sleeves all 8” x 5” x 1,000 = £59. Small Receipts: 2,000 = £48, 4,000 = £68. Des Currie: 01207 505191.

BERGMAN UK – For all your Orthotic Requirements 28 High Street Northallerton, North Yorks DL7 8EE. Telephone: 01609 781397 or 07877 986605.

Practice for Sale TORQUAY, DEVON - Surgery and domiciliary.

Established over 20 years. Retirement sale. Takings £17k plus - due to 3 day working. Scope for expansion. Price £18k.

Telephone: 07739 041919

For Sale:

Equipment for Sale

Footscan 0.5m plate with software for clinical gait analysis on a computer in your surgery. £4,500 ono.

Telephone evenings 01275 876109.

For general information on system, see www.rsscan.Co.Uk.

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Chiropody Services Security Video Technical Services Unit 239 Stratford Workshops Burford Road, London E15 2SP Tel: 020 8519 0044 Fax: 020 8519 1151

AMBERCHIROPODYSUPPLIES

Serving the chiropodist/podiatrist with all the essential daily consumable items for a busy practice, including: * Instruments & Equipment * Padding & Appliances * Dressings & Adhesives * Biomechanics

* Domiciliary * Sterilization * Diagnostics * Retail Products

To view our website/online store please visit:

Classified Advertisements www.ambersupplies.co.uk

80p per word - minimum £8.00 Box Number & sending replies: £4.00 extra Classified Advertisements placed by Members: 45p per word minimum £4.50

Trade Classified Advertisements Eighth page (minimum) £85.00 + VAT.

The closing date for receipt of Classified Advertisements is the 1st day of the month preceding publication i.e. Jan-Feb issue - 1st Dec.

All Classified Advertisements must be prepaid and sent to:-

Bernie, Chiropody Review, THE ADVERTISING DEPARTMENT, CHIROPODY REVIEW 27 Wright Street, Southport, Merseyside. PR9 0TL. Tel: 08700 110 305 or 01704 546141 Fax 01704 500477 Email: adman@iocp.org.uk

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Diary of Events June 2010

July 2010

Birmingham Branch

Surrey & Berkshire Branch Meeting

24th June at 8:00 p.m. Red Cross Centre, Vine Street, Evesham Tel: 01905 454116

3rd July at 1:30 p.m.

Greyfriars Centre, Reading

Leeds/Bradford Branch Meeting

West Middlesex Branch meeting

6th June - 10:00 a.m.

The Oakwell Motel, Birstall, Nr. Leeds WF17 9HD Tel: 01653 697389

12th July at 8:00 p.m.

The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544

Leicester & Northants Branch

September 2010

27th June Branch Meeting plus HPC audit guide Kilsby Village Hall, Registration & Refreshment 9:15 a.m.

Tel: Sue 01530 469816

Midland Area Council Meeting Sunday 13th June 10:00 a.m. Kilsby Village Hall, Kilsby, CV23 8XX Tel: 01865 434756

Tel: 0208 660 2822

Birmingham Branch 23rd September at 8:00 p.m. Red Cross Centre, Vine Street, Evesham Tel: 01905 454116

East Anglia Branch Meeting plus CPD 19th September at 10:00 a.m.

Newmarket Day Centre, Fred Archer Way, Newmarket CB8 8NT Tel: 01223 881170

Oxford Branch Meeting 5th June at 10:00 a.m.

89 Rose Hill, Oxford OX4 4HT

Tel: 01993 883397

Western Branch Meeting 13th June 12 noon Presentation by Darren Sandy “New Sterilisation Protocols” plus trade stand, Women’s Hospital, Crown Street, Liverpool Tel: 01745 331827

Essex Branch Meeting 19th September Education Centre, Southend University Hospital, Carlingford Drive, Southend on Sea Tel: 01702 460890

London Branch Meeting

Southern Area Council Meeting

8th September at 7:30 p.m. Victory Services Club, 63-79 Seymour Street, London W2 2HF Gordon Loader to give training in the use of Otoform to make silicon appliances Tel: 01895 252361

19th June at 1:00 p.m. Victory Services Club 63-79 Seymour Street, London W2 2HF Tel: 01992 589063

Midland Area Council Meeting

West of Scotland Branch Meeting

Sunday 12th September 10:00 a.m. Kilsby Village Hall, Kilsby, CV23 8XX Tel: 01865 434756

Sunday 6th June at 11:00 a.m.

The Express By Holiday Inn, Springkerse Business Park, Stirling FK7 Tel: 01796 473705

North West Branch Meeting

Wolverhampton Branch Meeting

Nottingham Branch Meeting

Sunday 27th June - 10:00 a.m.

4 Selman’s Parade, Selman’s Hill, Bloxwich WS3 3RN Tel: 0121 378 2888

Thursday 2nd September at 7:00 p.m. The Red Cross Centre, Nottingham Tel: 0115 932 8832

26th September

Tel: 0161 486 9234

Southern Area Council meeting Yorkshire Area Council Meeting 14th June 7:30 p.m.

Crispin, 13 Queen Street, Morley, Leeds LS27 0NU

34

11th September at 1:00 p.m.

Victory Services Club 63-79 Seymour Street, London W2 2HF Tel: 01992 589063

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South Wales and Monmouth Branch Meeting

Sussex Branch Meeting

5th September Taffs Well Ex Service Mans Club, Taffs Well Tel: 02920 331927

24th October at 9:30 a.m. The Bent Arms, High Street, Lindfield, RH16 2HP Tel: 01273 890570

Surrey & Berkshire Branch CPD meeting

Wolverhampton Branch Meeting

20th September at 7:30 p.m.

Pirbright Village Hall

Tel: 0208 660 2822

Western Branch Meeting 5th September 12 noon Blair Bell Education Centre

Sunday 10th October 10:00 a.m.

4 Selmanâ&#x20AC;&#x2122;s Parade, Selmanâ&#x20AC;&#x2122;s Hill Bloxwich WS3 3RN

Tel: 0121 378 2888

November 2010 Tel: 01745 331827

West Middlesex Branch meeting 13 September at 8:00 p.m.

The Harvester, Watford Road, Croxley Green,

West of Scotland Branch Meeting Sunday 19th September at 11:00 a.m.

The Express By Holiday Inn, Springkerse Business Park, Stirling FK7 Tel: 01796 473705

October 2010

Birmingham Branch 25th November at 8:00 p.m. Red Cross Centre, Vine Street, Evesham Tel: 01905 454116

Essex Branch Meeting 28th November at 2:00 p.m. Education Centre, Southend University Hospital, Carlingford Drive, Southend on Sea Tel: 01702 460890

London Branch Meeting 17th November at 7:30 p.m. Victory Services Club, 63-79 Seymour Street, London W2 2HF Tel: 01895 252361

Leeds/Bradford Branch Meeting

Devon and Cornwall Branch Meeting Please phone secretary for details The Exeter Court Hotel, Kennford, Exeter Tel: 01805 603297

7th November - 10.00 am The Oakwell Motel, Birstall, Nr. Leeds WF17 9HD Tel: 01653 697389

Leeds/Bradford Branch Meeting

Leicester & Northants Branch

3rd October - 10:00 a.m. The Oakwell Motel, Birstall, Nr. Leeds WF17 9HD Tel: 01653 697389

Midland Area Council Seminar Sunday 2nd October Kilsby Village Hall, Kilsby, CV23 8XX Please see inside Podiatry Review for details Tel: 01865 434756

North of Scotland Branch Meeting Please phone secretary for date and time The Heugh Hotel, Stonehaven, Aberdeenshire Tel: 01382 532247

Oxford Branch Meeting 9th October at 10:00 a.m.

89 Rose Hill, Oxford OX4 4HT

Tel: 01993 883397

Sheffield Branch Meeting October at 7:30 p.m. (date to be confirmed please phone secretary) SWD Sports Club, Heeley Bank Road, Sheffield Tel: 01623 452711

Surrey & Berkshire Branch meeting 11th October at 7:30 p.m.

Pirbright Village Hall

Tel: 0208 660 2822

28th November - Branch Seminar Lecture on Dermatology - Ivan Bristow, Southampton University, Trade support from Canonbury Autoclave servicing (by appointment), Lutterworth Cricket Club Registration and Refreshment 9:45 a.m.

Further details Tel: Sue 01530 469816

South Wales and Monmouth Branch Meeting 7th November Taffs Well Ex Service Mans Club, Taffs Well Tel: 02920 331927

West Middlesex Branch meeting 8th November at 8:00 p.m.

The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544

West of Scotland Branch Meeting Sunday 14th November at 11:00 a.m.

The Express By Holiday Inn, Springkerse Business Park, Stirling FK7 Tel: 01796 473705

December 2010 Leeds/Bradford Branch Meeting 5th December - 10:00 am The Oakwell Motel, Birstall, Nr. Leeds WF17 9HD Tel: 01653 697389

35

28902_Chirop_July/Aug_2010:17416_Chirop_Jan_Feb_08 Project1:ICP Advert 31/03/2010 10:17 Page 1

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National Officers

Branch Secretaries

President Mrs. F. H. Bailey M.Inst.Ch.P

Birmingham

Mrs. J. Cowley

01905 454116

Bradford

Mr. N. Hodge

01924 475338

Cheshire North Wales

Mrs. D. Willis

0151 327 6113

Devon & Cornwall

Mrs. M. Reay

01805 603297

East Anglia

Mrs. S. Bennett

01223 881170

Chairman Board of Ethics Mrs. C. Johnston M.Inst.Ch.P.,BSc(Hons)

Essex

Mrs. B. Wright

01702 460890

Hants and Dorset

Mrs. J. Doble

01202 425568

Chairman Board of Education Mr. W. J. Liggins F.Inst.Ch.P., F.Pod.A., BSc(Hons)

Kent

Mrs. C. Hughes

01303 269186

Leeds

Mr. M. Hogarth

01653 697389

Leicester & Northants

Mrs. R. Rose

01582 668586

London

Mrs. L. Towson-Rodriguez 01895 252361

North East

Mrs. E. Barwick

0191 490 1234

North of Scotland

Mrs. S. Gray

01382 532247

North West

Mr. B. W. Massey

0161 486 9234

Northern Ireland Central

Miss G. Sturgess

0289 336 2538

Northern Ireland Regional

Mrs. T. Patterson

0289 145 6900

Area Council Executive Delegates

Nottingham

Mr. S. Gardiner

0115 932 8832

Midland Area Council Mrs. V. Dunsworth M.Inst.Ch.P. D.Ch.M

Oxford

Mrs. S. Harper

01993 883397

Republic of Ireland

Mr. R. Sullivan

00353 5856 059

Northern Ireland Area Council Mrs. T. Patterson M.Inst.Ch.P

Sheffield

Mrs. D. Straw

01623 452711

Sth Wales & Monmouth

Mrs. J. Nute

02920 331 927

Surrey and Berkshire

Mrs. M. Macdonald

0208 660 2822

Sussex

Mrs. V. Probert-Broster

01273 890570

Teesside

Mr. J. Olivier

01287 639042

Western

Mrs. L. Pearson

01745 331827

West Middlesex

Mrs. H. Tyrrell

0208 903 6544

West of Scotland

Mrs. J. Drane

01796 473705

Wolverhampton

Mr. D. Collett

0121 378 2888

Yorkshire Library

Mrs. J. Flatt

01909 774989

Chairman Executive Committee Mr. R. Beattie Hon. F.Inst.Ch.P Vice-Chairman Executive Committee Mr. D. A. Crew OstJ, F.Inst.Ch.P., DCh.M

Vice-Chairman Board of Education Mr. J. W. Patterson BSc(Hons)., M.Sc., M.Inst.Ch.P Honorary Treasurer Mr. S. Gardiner M.Inst.Ch.P. BSc(Hons)PGDip Standing Orders Committee Mr. M. Hogarth M.Inst.Ch.P Mrs. L. Pearson M.Inst.Ch.P Secretary Miss A. J. Burnett-Hurst

North West Area Council Mr. M. J. Holmes M.Inst.ChP., D.Ch.M, BSc.Pod Republic of Ireland Area Council Mr. R. Sullivan M.Inst.Ch.P Scottish Area Council Mrs. A. Yorke M.Inst.Ch.P Southern Area Council Mrs. M. Newnham M.Inst.Ch.P Yorkshire Area Council Mrs. J. Dillon M.Inst.Ch.P

28902_Chirop_July/Aug_2010:17416_Chirop_Jan_Feb_08

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