Podiatry Review March/April 2013 by The Institute of Chiropodists & Podiatrists

Podiatry Review

40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 1

ISSN 1756-3291

Volume 70 No.2. Published by the Institute of Chiropodists and Podiatrists as a Peer Review Journal March/April 2013

• • •

Conference Booking Form Nominations for National Oﬃce

The “Rophi” Cushion – An Independent Report

INSTITUTE OF CHIROPODISTS AND PODIATRISTS

40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 2

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M A R C H /A P R I L 2013 V O L 70 N o.2

Editor Ms B. Hawthorn H.M.Inst.Ch.P.

Academic Editor Robert Sullivan BSc.(Hons) Podiatry, MSc. Pod Surg., PgDip M.Acu., FSSChP. FIChPA. M.Inst.Ch.P.

Editorial Committee Mr. D. Collett M.Inst.Ch.P. Mrs. J. Casey B.Sc., M.Inst.Ch.P. Mrs. J. A. Drane M.Inst.Ch.P.

Advertising Please contact Julie Aspinwall secretary@iocp.org.uk

Published by The Institute of Chiropodists and Podiatrists 150 Lord Street, Southport Merseyside PR9 0NP 01704 546141 www.iocp.org.uk

PODIATRY REVIEW

The Institute of Chiropodists and Podiatrists

Contents

Editorial .............................................................................2 The “Rophi” Cushion – An Independent report Dr. Ambreen Cohan, Mr Shaun P Kelly, Miss Katie Payne, Professor Jim Richards, Professor James Selfe ................3 Preliminary Study: Adolescent Idiopathic Scoliosis Linked to Abnormal Foot Pronation Brian A. Rothbart, DPM, PhD, DNM, FACFO ............................8 Foot Orthotics in Private Practice Elaine Eaton DipPodMed., Adrian Eaton MInstChP ..............12 World Glaucoma Day International Glaucoma Association ...............................15 2013 Conference News ...................................................17 2013 A.G.M. Booking Form ........................................18-19

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ISSN 1756-3291

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© The Institute of Chiropodists and Podiatrists. 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.

2013 Conference News ...................................................20 Diabetes News Diabetes UK.....................................................................21 Do Epilepsy and Migraine share a genetic link? NHS Choices ....................................................................26 Branch Profiles ................................................................28 Meningitis “Coffee Break”...............................................31 Nominations for National Office .....................................33 Classified Adverts ............................................................34 National Officers..............................................................35 Diary of Events ................................................................36

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EDITORIAL Dear Readers,

Welcome to this spring issue of Podiatry Review. As William Shakespeare put it “April hath put a spirit of youth in everything (Sonnet XCVIII)”. Spring is always a time for looking forward to new beginnings with renewed vim and vigour. Our new premises on Lord Street is taking shape nicely and the garden is ‘coming to life’ with lots of birdlife. It is a lovely place to work and we hope our patients and visitors feel the same.

We, at Head Oﬃce, are also looking forward to our 58th annual general meeting and conference which again is to be held in Southport due to its huge success last year. If you have not already booked, please take a moment to read the centre page pull out section starting on page 17. Conference is a really inexpensive way to fulﬁl your CPD commitments as well as the opportunity to discuss products with the experts and to churn over ideas with your peers over tea and biscuits or glasses of wine! Anybody who has not been to a conference will be surprised at how much they enjoy it. Last year we had a member who travelled all the way from Trinidad especially for our conference. She was apprehensive about attending alone but remarked afterwards that we were a really friendly organisation and she had met lots of ‘friends’. This year we have visitors from Australia! We thank the authors and the University of Central Lancashire for allowing us to publish their independent report on the “Rophi” Cushion. It is claimed that “The Rophi Cushion is a

simple, eﬀective and aﬀordable way to relieve back pain – also known as spinal stenosis. The cushion, which sits in a purposemade stocking, aligns the spine and pelvis whilst you sleep, relaxing your back muscles and allowing them to heal naturally.”

Following on from this we have a “Preliminary Study: Adolescent Idiopathic Scoliosis Linked to Abnormal Foot Pronation.” from Professor Brian Rothbart who has over 40 years’ experience as a physician and researcher. Before his work there was no such thing as chronic pain elimination; only chronic pain management. The peer reviewer remarked that this article was quite an interesting hypothesis that requires further study and will no doubt promote further debate which we welcome from you. We also look forward to hearing from Professor Rothbart, in time, with the ﬁnal study results.

The secretaries of Leeds/Bradford and Wolverhampton branches respectively, have provided short profiles. As with all branches, many more members could attend their branch meetings. All branches are welcome to apply for the branch endeavour award. Why not get pro-active and help your branch to win this award? Finally, take a look at page 31. The Meningitis Trust is encouraging people to organise a ‘coffee break’ in order to raise funds for people who have been affected by meningitis. Please do consider this very special cause. Happy reading! Bernadette Hawthorn, Editor

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40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 5

ARTICLE

The “ROPHI” Cushion An Independent Report

Dr. Ambreen Cohan, Mr. Shaun P. Kelly, Miss Katie Payne, Professor Jim Richards, Professor James Selfe

Back pain has become a worldwide problem, affecting 80% of the western world (Frymoyer and Cats-Baril, 1991). It is often related to poor posture or movement, causing tissue overload and pain (Comerford and Mottram, 2001). The associated symptoms, pain and disability, often interfere with work, daily activities and sleep (Jensen et al., 2000, Noren et al., 2002, Wang et al., 2004). A large prospective cross-sectional study found a highly significant relationship between lower back pain (LBP) and quality of sleep, with reports of a 55% increase in restless/light sleep following the onset of pain (Martin et al., 2006). This supports the literatures recognition that sleep disturbance is a clinically important symptom of LBP (Hurley et al., 2010). Rotation is an essential movement of the spine and is incorporated into many daily activities (Crosbie et al., 1997; Rowe and White 1998; Morl et al., 2005) This can lead to tissue damage (Farfan et al. 1970) To overcome this, Gracovetsky (1987) advised a sleeping posture similar to that of the foetal position. This was thought to limit unnecessary rotation of the lumbar spine, that often causes torsional injury, through maintenance of a “neutral position. Further theoretical mechanisms to alleviate such pain and poor sleeping posture often involve sleeping in a side lying foetal position with a cushion between one’s legs. This position is thought to align the spine, reduce further pain and alleviate pressure on the opposing leg. The “Rophi” cushion attempts to utilise this theory to provide spinal alignment and improve sleeping posture. However, there is little biomechanical evidence available as to the true impact of such theories on spinal alignment and their role in reducing back pain.

OBJECTIVES To assess whether the Rophi Cushion improves the biomechanical alignment of the spine when lying in a semi-foetal position, in people with simple mechanical lower back pain. To assess the subjective experience of pain and comfort before and after the use of the Rophi cushion.

PARTICIPANTS Fifteen participants with simple mechanical LBP (aged 44 ± 9.7 years; BMI 27.01 ± 4.28 kg/m2) were recruited to this study. Prior to participation, volunteers with LBP were screened for eligibility using the Red Flags Screening form (Greenhalgh & Selfe, 2010). Volunteers with multiple red flags were excluded from the study and participants with no red flags were included. The study was approved by the University of Central Lancashire Ethics Committee and was performed in accordance with the Declaration of Helsinki (WMA, 2008). Written informed consent was obtained from each individual prior to participation.

PROCEDURE

MEASUREMENT OF PAIN AND COMFORT DURING SLEEP Prior to the testing session, participants were asked to fill out a short assessment aimed at assessing sleep quality, sleep patterns, pain and back stiffness. Participants were then asked to use the Rophi cushion for one week, before completing a second assessment. The “Pain and Comfort during Sleep” assessment was based on methods previously utilised by Jacobson et al. (2010). The assessment focused on 4 main aspects: 1) Sleep comfort, 2) Quality of sleep, 3) Back pain when waking 4) Joint or Muscle stiffness when waking. It is common for individuals with LBP to adopt a certain sleeping position or favour one over another to reduce discomfort during sleep, however participants were asked about their average sleeping positions.

The Visual Analogue Scale (VAS) is common practice, having been used extensively in similar studies (Jacobson et al., 2008, 2010; Marin et al., 2006). The scales provide an accurate pre and post intervention measure of subjective pain and comfort. Participants were given directions on how to use a VAS to assess the dependent variables (back pain, back stiffness, sleep quality and comfort). The VAS consisted of a line with polar extreme labels to discriminate between “None” and “Extreme” for example during pain. Participants were asked to rate each variable in turn and place a mark on the scale at the point that best represented their perception of their pain/comfort. In addition to the above questions, two questions regarding the perceived benefit of the cushion post intervention were asked, to assess the potential impact of the cushion on people with simple mechanical LBP.

MOVEMENT ANALYSIS All participants were required to attend a single testing session at the movement analysis laboratory, based at the University of Central Lancashire. Retro-reflective markers placed on the pelvis, lower limbs, lumbar and thoracic spine allowed segmental analysis of the spine and lower limbs in the sagittal, coronal and transverse planes using the calibrated anatomical system technique (CAST) (Cappozzo et al. 1995, Preuss and Popovic, 2009). Movement of the markers was recorded using a10-camera Oqus Qualisys motion capture system. Participants were required to lie in a semi-foetal position on a standardised bed, with and without the “Rophi” cushion (Figure 1). Head and neck position was standardised using an orthopaedic cushion. All data were analysed using Visual3D (CMotion Inc.) and Microsoft Excel. page | 03

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ARTICLE RESULTS

PAIN AND COMFORT DURING SLEEP The “Pain and comfort during sleep” questionnaire was carried out pre-testing then again following a one-week intervention. Prior to testing the participants spent an average of 68.7% of a typical night sleeping on their side, this was increased by approximately 7% during the intervention as participants were instructed to make a conscious effort to sleep in the semi-foetal position with the Rophi Cushion (Figure 3).

There was a significant 36% reduction (p=0.01) in back pain intensity experienced during sleep after one week of using the Rophi cushion. Similarly back stiffness experienced when waking, significantly reduced (p=0.003); demonstrating a 33% improvement on average (Figure 5).

Figure 4: Number of days participants experienced poor sleep quality or woke with back pain or joint/muscle stiﬀness pre and post-intervention

Figure 1: The Rophi cushion worn by a participant during testing

Figure 2: Example participant modelled in Visual 3D (C-Motion Inc.)

Figure 3: Percentage of time spent in each sleeping position pre and post-intervention

Pre and post testing, participants were assessed for poor sleep quality, back pain and joint or muscle stiffness on waking based on the number days these were experienced. There was a significant reduction in the number of days poor sleep quality experienced (p=0.026) and the number of mornings participants awoke with back pain (p=0.04). However, due to variation in subjective experience there was no significant improvement in the number of days participants awoke with joint or muscle stiffness overall, though on average this appears to reduce (Figure 4). 04 | page

A 38% improvement was seen in perceived sleep comfort (p=0.003) through use of the Rophi cushion (Figure 6). Although there was an average 24% improvement in sleep quality, this wasn’t quite significant (p=0.069).

BENEFIT AND COMFORT OF THE ROPHI CUSHION On average participants rated the Rophi cushion comfortable with a skew towards “Excellent comfort” on the VAS scale. Overall participants perceived a benefit from the cushion, with the majority of participants skewed towards it being “Extremely beneficial” (Figure 7). KINEMATIC DATA The kinematic data for the participants, for the average angle over a 5 second period of sustained lying with and without the Rophi cushion is presented in table 1.

Results show that the main significant differences in joint angles occur at the hip (in all three planes) and between the lower lumbar region and the pelvis (in the coronal plane). This indicates that the Rophi cushion causes a reduced adduction angle of the hip (approximately 5°), moving towards a more neutral position and causes the hip to externally rotate by approximately 7°. The small yet significant change in the pelvic to lower lumbar alignment in the coronal plane (0.6°) was seen consistently for all participants. There were no further significant differences in joint position at the knee, within the lumbar spine region (Upper lumbar to lower lumbar) or between the lumbar and thoracic spine.

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ARTICLE

Figure 5: Box-whisker plots of back pain intensity during sleep (left) and back stiďŹ&#x20AC;ness when waking (right) before and during use of the Rophi cushion

Figure 6: Box-whisker plots of perceived sleep quality (left) and sleep comfort (right) before and during use of the Rophi cushion

Figure 7: Box-whisker plots of perceived comfort (left) and beneďŹ t (right) of the Rophi cushion

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ARTICLE

DISCUSSION The Rophi cushion aims to alter spinal alignment to a more neutral position in order to improve sleep quality and reduce back pain on waking. The findings of this intervention study in a group of individuals with simple mechanical lower back pain, suggests that the cushion shows benefits in repositioning of the hips and the lower back. In turn, this could be responsible for the improvement in back pain and sleep comfort experienced. 06 | page

The simple one-week intervention showed:

• A reduction in the number of days poor sleep quality was experienced. • A significant reduction in frequency and intensity of lower back pain experienced. • A significant reduction in back stiffness when waking. • A significant improvement in sleep comfort.

40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 9

ARTICLE This indicates that the overall experience was of some distinct general benefit. Overall the Rophi cushion was rated as comfortable and of some perceived benefit.

Biomechanical assessment of the Rophi cushion when worn on the top leg, whilst lying in a semi-foetal position caused 5° less hip adduction, around 7° of external rotation of the hip and small yet significant changes in the coronal plane alignment of the lower spinal to pelvic region. Overall it appears the individual is moved towards a more neutral position when using the Rophi cushion Overall the small changes in hip and sacro-pelvic alignment when using the Rophi cushion are coupled with an improved subjective experience post-intervention. It is possible that the potential risk of muscle strain or pain caused by torsional stress is alleviated due to the adjustment towards a more neutral position. Though results show that on average the individuals spent most of the night in a side lying position, it is possible that the legs are not necessarily aligned on top of one another. Due to the increased pressure at the knee this position is not a long term, sustainable sleeping posture for all individuals. With the Rophi cushion however, it is possible this pressure is reduced and the cushion acts as a proprioceptive feedback mechanism to prevent the torsional stress possible in alternative positions, training the individual to sleep in this manner. Additional feedback from individuals showed that in general, those that usually spent the least time in a side lying position found less overall benefit. Therefore the consideration that this product requires individuals to spend a large proportion of the night in a side lying position should be kept in mind to ensure maximum benefit to be gained by potential users. Other general feedback from individuals who used the cushion for one week, suggested that the stocking around the cushion looses it’s

elasticity after a few uses, causing the cushion to rotate around the knee during the night, which should be considered further. REFERENCES

Capozzo, A., Catani, F., Croce, U. D., Leardini, A. (1995). Position and orientation in space of bones during movement: anatomical frame definition and determination. Clinical Biomechanics. 10, 171-178

Comerford, M. J., & Mottram, S. L. (2001). Movement and stability dysfunction - contemporary developments. Manual Therapy , 6 (1), 15-26. Crosbie, J., Vachalathiti, R. and Smith, R. (1997). Patterns of spinal motion during walking. Gait and Posture , 5, 6-12.

Farfan, H. F., Cossette, J. W., Robertson, G. H., Wells, R. V. and Kraus, H. (1970). The effects of torsion on the lumbar intervertebral joints: the role of torsion in the production of disc degeneration. Journal of Bone Joint Surgery, 52A, 468-497.

Frymoyer, J.W., & Cats-Baril,W. L. (1991). An overview of the incidences and costs of low back pain. Orthopaedic Clinics of North America , 22 (2), 263-271.

Gracovetsky, S.A., 1987. A conceptual approach to the avoidance of spinal re-injury during rest. Physical Therapy 67, 549-553.

Note: Further to this trial a much larger trial has been carried out which has resulted in this product gaining PPA (Prescription Pricing Authority) approval, and is now listed as a medical device which can be prescribed. With this approval the ROPHI Cushion is now available for retail through private clinics and organisations. For further details Tel: 01254 677341

Leeds/Bradford Branch Will be holding a FULL DAY CPD SEMINAR At

Huddersfield University on Saturday 16th November 2013 Make a diary note Further details to follow page | 07

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ARTICLE

Preliminary Study: Adolescent Idiopathic Scoliosis Linked to Abnormal Foot Pronation Brian A. Rothbart, DPM, PhD, DNM, FACFO Prelude

Scoliosis in patients between 10 and 18 years of age is termed adolescent scoliosis. The most common type of scoliosis in this age group is one in which the cause was unknown, and is still referred to as Adolescent Idiopathic Scoliosis (AIS).

I have long suspected a link between abnormal foot motion (e.g., hyperpronation) and the development of abnormal curves in the spinal cord. A study I published in 2006 statistically linked the unleveling of the pelvis, which forms the base of the spine, to abnormal foot pronation. It is only logical to suspect that if the base of the spine is unlevelled, it could also unlevel the entire spine. This was my motivation that led to the current study, published below. It is to be noted that this is a preliminary study and certainly not deﬁnitive. However, the outcome of this study does suggest that the development of scoliosis may indeed be linked to abnormal foot motion. In order to conﬁrm or refute this suggested link, larger statistical studies need to be done which ideally would be double blinded. Abstract:

In a preliminary study of 25 teenage patients with asymmetrical abnormal pronation patterns and a positive Adams Test, a positive statistical correlation was found between: the pronation pattern, the pelvic distortion pattern, and the pattern of frontal plane deviation within the thoracic spine.

Discussion:

Adolescent Idiopathic Scoliosis is a two dimensional deformity (lateral and rotational) of the spinal column in the absence of associated congenital or neurologic abnormalities. Onset is between the ages of 10 and 18. Longitudinal studies (Yawn et al, 1999; Soucacos et al, 1997) estimate the prevalence as high as 2% of the adolescent population, using a deﬁnition of a spinal curve greater than 10 degrees. (A side to side curve of at least 10 degrees with a rotational deformity, of at least 10 degrees, must be present before AIS can be diagnosed.) Side to side (frontal plane) curves greater than 20 degrees have a distribution of 5 females for every male.

Purpose of Study:

To determine if a correlation exists between abnormal foot motion (in this case abnormal foot pronation) and

08 | page

the development of scoliotic curves. In this study I only included those subjects that (1) abnormally pronated and (2) were positive for the Adams test. I ran a t-test on the clinical data to determine if a positive correlation existed between the prominence of the scapula wing, the direction of the thoracic curve and the abnormal pronation pattern. A positive correlation was identified in this study. From clinical experience, we know that many abnormal pronators do not develop significant scoliotic curves (Cobb angle greater than 20 degrees). I believe the development of scoliotic curves is a multifactorial issue. There are other factors that still need to be identified if we wish to understand why only a few patients end up with significant scoliosis. The 25 patients in this study had a sundry of chronic musculoskeletal complaints. Many of these symptoms were contributed more to the abnormal pronation than directly to the scoliosis. In this preliminary study I made no attempt to separate the cases into functional or structural scoliosis. I believe that a rotated and unleveled pelvis is one of the biomechanical determinants that make an individual more prone to develop scoliosis.

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ARTICLE Inclusion Criteria:

• All subjects diagnosed as Ideopathic Scoliosis

Figure B: Spinal Distortion

• All subjects under the age of 18

• All subjects have thoracic curves

Procedure: The following null hypothesis was constructed and tested using the One Sample t-Test (Analyse-it + General, version 1.73) on the raw date (see below). • Hoa: There is no relationship between the most pronated foot and the direction of the thoracic curve Results: One-tailed P value = 0.0415

Conclusion: At conﬁdence level = 99%, the null hypothesis Hoa was rejected

Figure A: Raw Data

Legend: Pfg = Greatest Pronated Foot TCd = Direction of Thoracic Curve PPs = Side of Posterior Protuberance (determined using Adams Test) PPm= Measured Posterior Protuberance (using spinal inclinometer, see photograph below)

If the pattern of pronation was right > left, the pelvis was rotated counterclockwise and tilted downwards towards the right side (See diagram above). The left shoulder was rotated forward and downward with a protruding right scapula wing. The thoracic scoliotic curve was on the right side. Conclusion: this study suggests that asymmetrical pronation patterns may be a critical factor in the development of scoliotic curves. Interesting enough, in the screening process, I found no patients with signiﬁcant scoliotic curves that did not abnormally pronate.

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ARTICLE

Spinal Inclinometer. Measuring the spinal curve

References Soucacos PN, Soucacos PK, Zacharis KC, 1997. School Screening for Scoliosis. A Prospective Epidemiological Study in North-western and Central Greece. Jour Bone Joint Surgery 79:1498-1503. Yawn BP, Yawn RA, Hodge D, et al 1999. A Population Based Study of School Scoliosis Screening. Jour American Med Assoc, 282:1427-1432.

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They # $ $ $ $ $ $ $ $$ $ $ $ $ $$ $ $ $ $ $ which $ $ accompanies $ introduced Orthotic Lab International $ $ $ $ us to $ $the $ Precision $$ $ $ $ $ $ $ the digital casts $ $ detailed =$ $ $ $ $ $ $ $ $$ $ $ prescription $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $$ $ $ $ $ $ $ in$ the USA. $ $ $ $ $ $ $ $$ $ $ to the lab. $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ $$S/$.*O$#'/1$#"$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ time, $ $ $ $scanners $$Q'/5$(+#&";C)/;$C*$#"$ $ $ At $that $ $ the$ latest $ $ laser $ $ were$ being 2We believe $ $ $ $ $ $ $ $to understand $ $ $ $ $ $ it is important $ $ $ for$ patients $$S/$.*O$#'/1$#"$ $ # $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $$S/$#.9O$.F"C#$#'/$R$&")O/&$ developed in the USA to take a 3 dimensional$ digital cast 2why they $ $ are $ having $ $ the problems $ $ $ they$ have $ as this helps $ = $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $$ $ $ $ $ . $ $ $ $$Q'/$H(&*#$(*$#'/$'//9$&")O/&A$*/)"+;$(*$ $ $ $ $ $ $ $ $ $ of plaster of paris or foam $ process $ of us being$$S/$#.9O$.F"C#$#'/$R$&")O/&$ able to help them. We ask them $ $ the $ feet$$ instead $ of the$ usual $ $ $$Q'(*$/+.F9/;$C*$#"$ $ $ in# the $ $ $ $ $ $ $$ $$ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ $ $ a rocker$ and $this $ $ $ $ $ $ .to picture $ $ their $ foot $$Q'/$H(&*#$(*$#'/$'//9$&")O/&A$*/)"+;$(*$ * $ casts. $ $ $ $$ $ $ $ $ as $being $$ $ $ $ $$ $ $ $$$Q'(*$/+.F9/;$C*$#"$ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ $ $$S/$.*O$#'/1$#"$ # $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ visualisation helps their understanding. We talk about the * $ $ decided $ $ invest $ $ in the laser$ scanner $ technology $ We to 2$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $$ $ 3 rocker actions of the $foot. The first is the heel rocker, $ $ $ was $ $ $ $Precision $ $ $ $and $ which $ $ created $ by$ recommended by $ $ $$S/$#.9O$.F"C#$#'/$R$&")O/&$ $ $$ $ ankle $ rocker $ where $ $ leg$ moves over$ the$ $ $ based $ $ LA. This $ $ $ us $ second$ is the the $ Alex $ $ Sharpe $ of $Sharpe Shape, in enabled . $ $ $ $$Q'/$H(&*#$(*$#'/$'//9$&")O/&A$*/)"+;$(*$ S $ $ $$ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$Q'(*$/+.F9/;$C*$#"$ $$ ankle$$ and $ $ is$ the $ $ $ rocker. $ $$ to casts # $ the $ third $ forefoot $ $ $ $ $ $ send $ digital $ $ $direct $ $to the $ Laboratory, $ $ $ $ giving $ $ us $ a $ $ $ $ $ $ $ $$0/&/$ * $ $ $ $ S $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ normal turnaround of 7 working days or an express There are many cases which have been challenging and $ $ $$ $ $ $ $ $ $$ $ $ $ . $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ to have $ $ the$ input$$0/&/$ service $ $ $$at$ 3$ days. $ $ $ $ $ $ $ $ over $the$ years it has$ been invaluable $ $ $ $ $ $ $ $ $ . 7$ $ $$ $ $$ $ $ $ $$ $ $ $ $ $ $ $ $the DPM’s $ $$ $ at $the $ from other professionals, particularly $ When $ $ the UK $ laboratory $ ceased $ $ $ $ we dealt its$operations, $ $ $ $ $ $ $ $ $ $ $ $ $ Lab. Here are two of the many patients we have helped. $ $ $ $ $ $ $ $ $ $ $S $ 7 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ directly with Precision and have been doing so for the $$?+-/*#(J.#("+$ $ building$ up a$ good$ rapport $ and $ $ $ $ $ $ $ $ 1 is $ $ $ $ $ $ $ $ $$0/&/$ past 10$years, Example * $ $ $ $ $ $ $ $ $ $ $ $ $$?+-/*#(J.#("+$ . who $ has $ an $ $ $ $ $ $ $$ understanding, allowing us to provide bespoke foot Dorothy $ $ $ $ $ $ $ $ $ $ $ $ $ $ * $ $ $ orthoses for a wide range of conditions. exostosis$ on $the $ $ $ $ $ $ $ $ $ $ $ $ $ 7 $ $ $ $$$ medial $ arch $ $$of $her $ $ $ $ $ $ right foot. $ $$?+-/*#(J.#("+$ $ $ $ $ $ *$ Investigation showed $ $ $ $ $ $ $ $ $ $$ $$ $ $ $ $ $ $for $$ $ $ $ $ $ $ $ $ $ $ no sinister reason $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ bony$ growth, $ $ $ but $ $ $ $ $ $ $ $ $ $ $ the $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ walking $ $ on$ $this$ was$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $! $ $ $ $ $ producing $ $ $ painful$ $and $ was $ $other $ problems $ $ such$ incredibly $ $ $ $ $ $ $ $ As well as very functional devices, following demand, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $! $ $ $ $$ $ $ $ $ $$ $ $ $ $ $ $ as back $ $ and$ hip $ pain $ as she was $ $ trying $ to avoid $ $ contact $ $ we $ have $ $ $ made $ $ them $ $ $ $ $ $ of$ colour $ $$ $ also $ $ $ $$ $in a$ variety $ $ $ schemes, $ $ and off area. $ load$the $ painful $ $$S/$;/)(;/;$"+$HC99$9/+J#'$ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ $particularly $ $ $ for $ $ female$patients,$as$they$wanted $to $have $a $ "As always$ we$ had $ conducted$a full$ lower $ $limb assessment $ $ $ $ $ $ $ $ $$S/$;/)(;/;$"+$HC99$9/+J#'$ $ $ $ $ $ $ $ $ $ $ $ $ more$ aesthetically$‘pretty’$device$when$wearing$sandals$ $ $ $ $ $ $ $ $ at$ $ foot $ $ $ $on full $ length $ orthotics, $ $ wear. We decided $ and$ also$ when$ going$ shoe$ shopping.$!This $all $helps $ensure $ "and looked $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $$ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12 | page $ $ $ $ $$S/$;/)(;/;$"+$HC99$9/+J#'$ $ $ $ $ $ $ $ $ $ $ $ $ $ " $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

$$ $$

40025 Ch opody Ma Ap 2013 12 02 2013 09 12 Page 15

$ $ $ $ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ARTICLE $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$$$Q'/$$ $ $ $ $ $ $ $ $ $ $ $ $ $ 2 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$$$Q'/$$ $$ $ $$$ $ $ $ functional orthoses to support her feet.$ $ $ 2 on a compressible $ $ post$ to the $ $(just behind$ the$ $ sulcus $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ metatarsal heads), which would provide optimum control to $ $ $ $ $ $ $ Q$ $ $ $$$$$$$$ The photo 2 shows the stage $ ' $ $ $ $ $ $ $ with$ extrinsic $ $ postings. $ $ We$ also had a larger cut the forefoot $ $ $ $ $$$$$$$$$$$$$$$$$$ $ of Annabelle feet just as we $ side of $ the $ shell and $ increased $ Q'/ the $$$$Q'/$$ $ $ $ $ $ $ ' $ $ $ $$ out on the$ medial $ $ were taking this next step. $$ $ $ $ $$ $$ $ 2 $$ $ 2padding to support $ $ $ $the exostosis. $$$$$Q'/$ $ $$ $ $ $ The$ photograph above 2 $ $ $ $ $ $ $ $ $ Again we monitored her $ $ $ $$ $ $ $ $ $$ shows how well this supported the foot. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$$$$$$$$$$ progress carefully and photo 3 $ $ $ $$ $ $ $ $ $ $ $ $ $$$$Q'/$ $ $ $$ Q'/ $ $ $ $ I$ I $ $$ $ $$ $$ $ $ $$$$$$$ Dorothy was happy to walk out pain free '$ $ $ ' $ $ $ $ after a further year$ shows the $ $ $ $ $ $ $ $ $ $ 22 $ ' $ $ $ $ $$$ $ $ alignment, which $ $ both$$ she $ $and$ $$ $$ $ $ $ $$ $ $$$ $$ $$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ happy $ $$ with. $ $$ her parents $ are$very $ $ $ $$ $$ $$ $ $ $ $ $$ $ $$$$$$$$$$$$$$$$$$ ' $$ $ $ $$S/$C*/$.$^$;/J&//$9.#/&.9$ $ $ $$ $ $ $ $ $ $ $ $ ' $ $ $ $ $ Another $ $$$ $ $ $ $ $ $ $ $$$$Q'/$$ $ a$ $ $ on B $ $ $ $ $ variation $ $ $ $$ $ $ $ $ $ $$$ $ $$ $ $ $ $ 2 $ $ $ $ $ $ $ $ $ $$$S/$C*/$.$^$;/J&//$9.#/&.9$ bespoke foot orthoses which $ $ $ $ Q $ $ $ B $ $$ $ $ $$ $ $ $ $ $ $$ $$ $ $$ $ $$ $ $ $ $$ $ $ $ have $$ $ $$beneficial $ $ $ $$ $to $ $$ $ $ $$ $ $ $ $ $ $$ $$ $we $$ $$ $ $ found Q $ $ $ $ $ $ $ $ $ $ $ $ $ $$$$$$$$$$$$$$$$$$ $$ $ $$ $ $$ $ $$ $ patients $ $ $ $$ $$ $ $ $ $$ $ $ is$ the $ $ $ use$ $$ of$ a$ $lateral $ $ ' $ $ $ $S/ $$$S/$C*/$.$^$;/J&//$9.#/&.9$ $$. ^$ $;/J&// $$ $ $$ .#/&. a full device in$ $$ $$ $ on $$length $ C*/ $ $$ $$$ $$$ $ $ $ wedge $ $$ $ $ of $ tibiofemoral $$$S/$C*/$.$^$;/J&//$9.#/&.9$ $$$ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ the $ $ treatment B $ B $ $ $ R$ $ $ $B $ $$ $ $ $$ $$ $R $$ $$ $ $knee $ $ Q $$ $,'"#"$R$ $ $ $ $ $ We osteoarthritis. use a$4 $$ $ Q $ $ $$S/$C*/$.$^$;/J&//$9.#/&.9$ $ $ $ $ $ $ S/ C*/ . ^ ;/J&// .#/&. Q $ $ $ $ $ $ $ $ $$ $ $ and $ patients $ have $ $ this $ $ $ degree$ lateral found $ $ $ wedge $$ $ $$ $ $ BB $$ $ $ $ $ $ $ $ $ $ $ $ $ $ to wear. The lateral wedge increases rear Qcomfortable $ $ $ $ $ $ $ $ Q $$ $ $ $ $ $ $ $ $ $ $ $ padding and a dell to The full length orthotics with increased foot pronation and changes the way is loaded,$ $ the knee $ $ $$ $ $ $ $$ $ $ $ $ $ $ $$ $ $ support the exostosis$ $ $ the$ pressure $ at the medial aspect. reducing $ $ $ $ $ $ $ $ $ $ QThe $ $ $ $$ second$ case$ we$ would$ $ $ $ $$S/$C*/$.$^$;/J&//$9.#/&.9$ $ $$ $ $ $ $ $ $ $ $ $ how Q $$like to share $ $ $ shows $ $ $ $ B $ $ $ $ $ $ $ $$ $ $ orthotic $ intervention $in $ $ $ $$ $ Q $ $ $ $ $ $ $ $ $ $ $$$ $ $ make a$ huge $ children$ can $ $ $ $ $ $ $ $ $ $ $ difference. $ $$$ = $ $ $ $ $$ $ $ $ Q $$ $ $ $ $ $ $ Q $ $$=*$ $$ $ Q $$$$ $ $ $ first $ $visited Annabelle = $ $ $ $ $$ the $ $$ $ $ $ $ $ an$$$ $assessment $ $ $$ $ at $ Q Q $$ practice $5 $$ $ for $$ $ $ $ $ $ $ $$$$=*$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $$ $can 3$$ 3 $ 5 $ $ $age $$$$$$see from the $ $ 12.$$ $ As you $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $$ $ $ $$ $$ she $in-toed $ $ $ $ $ $ $ $ $ $ $ photograph, $ $$$ $ N $ $ $ $$ $$ $ $ $ $ $$$$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $She $$ excessively and as= a result,= didn’t like to play sport. ^$$ 4 = $ ^ $ $ $ $ $ $ $ $ $ $ $$ $ $$$=*$ $$ $ N $often $tripped $up $and $=was $embarrassed. $ $ $ = $ $ $ $$ $ $ =*$$ $ $ $$=*$ $ $$ $ $ $ $ $$ $ $ $ $=* $ $$=*$ $ 5$$ $$ $$ $ $ $ $ $ $ 5 $ $ $ $ $ $ Photo 4 is without $ $ $ orthotics $ $ $ 5 with $ orthotics $ $ $ $ We advised $ $ her parents $$5$$ we Q $ 5$ $$ that and photo $ $ $$ $ $$ $ $ $$ $$ $$ $ $ 5 $ $ $ $ $ $ $$ $ $ $ $ $ $$ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ $$$ $ $ increasing $ $ $ $ $ $ $ the rear foot pronation and giving better foot would have$ to$ adopt$ an$ $initial $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $$ $$ $ $ $ $$ $ $ $ $ $ $ $ $ $ $ $ $$ alignment. $$of trying $ $ $ $ the $ $$ $ $ $ $ $ $ $$ $ $ $ $$ $ $ $ $ $ $ Napproach $$ $ to$ stop $ $ in$ $ $ $ $ $ $ $ N $$$ $$ $ $$ $ $ $$ $ $ $ $ $$$ $ $ N $$$and we N N $toeing prescribed a$ bespoke $$$ $ $ $ $$ $ $ $ $ $ $ $$ $ $$ $ $ $ $ $ $ gait plate, where the plate of the $ $$ $ $ $ $ $ $$=$ $ $ $ $$$ $ $ $$$$$$ $ $ $ $ $ $ $ $$ $$ $ $ $ $$ $ Q$ prevents $ $ $ $ $the $ foot from $ $pushing $ $ $ shell $$ $ $ $ $ $ $ $$ $ $ $$ $ $$ $ $$$ $ $$$ $ $$=*$ Q $ $ $ $ $ $ $ off at the lateral aspect during $ $ $ $ $ $ $ $ $ $ $ Q $ $$ $$ $ $ $5 $ $$ $ $ $ $ $ $ $ $ $ $$ $$$ $ $$ $$ $ $$$ $$ $ $ $ $ $$$Q$$ $$ $$ $ $ $ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ propulsion. $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $$ $ $ $ $ $ $$ $ $ $$ $$ $ $ $$$$ $ $ $ $$$$$$ $ $ $$ The foot $ $falls medially$ and the $ $$$$$ $ N $ $ $ $ $ $ $ $ $$$ $ $ $ $$ $ $ $ $ $$$$ effect is the forefoot is forced to $ $ $ $ $ $ $ $ Q$ $$ $ $ $ $ $$ $ $ $ $ $ Q $ $ $ $ $ $ $ $ Q $$ abduct. This type of device can $ $ $ $ $ $ Q $ $ $ $ $ $ $ Q $ $ $ $ $ $ $$ $ $ $ $ $ $ $$ $ $ $ $$Q $ $$ Q$ $$ $ $ $ $ $ $ $excessive Qso $ $ $ $ $ $ $ $ $ Q $ pronation we Q $ cause $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Gait Plate $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$$ $$$ a$ $close $ $ $$ $ $$ had $ $ to$$ keep $$ $ $ $ $$on $$$ $ check $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $After $ $$ a period $ $ $ $ $9 months, the in$ $ $ $ $ $ $ $ $ $ $ $ $ Annabelle’s $$ $$$$$ $ $ progress. $ $ Q $$ $$ of $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $$ and $ $ $ $ $ $ $ $ $ $ $ $ then $ $ $$ $had $ $ $$ prescribed $$$ we $ $ $ toeing a normal $ $ $ $improved $ _ T $$ $ $ $ $ $ $ $$ Q $ $ $$$$$ $ $$ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $$ $ $ $ $ $ $$$$ $ $$$ $$ $ $ $ $ $$$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ page $ $ |$ 13 $ $ $ $$ $$ $ $ Q $ $ $ $ $$$$ $$$$ $ $ $ $ $$ $ $ $ $ $ $$$ $ $ $ $ $ $ $ $ $ $ $ $$ $ $$ $ $$ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $$ $$ $ $ $ $$$ $ $ $$ $ $ $ $ $ $$ Q $ $$$ $ $ $ $$ $$ $ $ $$ $ $ $ $$ $$$ $ $ $$ $$$ $ $$ $$ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ Q Q$ $ $Q $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $$ $$$ $ $$$ $ $ $ $$$ $ $$ $ $ $ $ $ Q $ $ $ Q $ $ $ $ $ $$$ $$ $$ $ $$ $$ $ $ $ $ $ $ $ $ $ $ $$$ $ $ $ $ $ $ $$ $ $ $ $ $ $ $$$$ $ $

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40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 16

ARTICLE Photo 6 is without orthoses and photo 7 is with normal functional foot orthotics. The patient had already had knee surgery and was more suited to this device, which improves alignment and left foot pronation.

These are all examples of bespoke foot orthoses used in our practice and have been used to show just some of the many conditions which we treat. As well as bespoke devices, we have of course used readymade or off the shelf orthotics from many different suppliers. Our patient’s main concern has been shoe fit. We were delighted to learn that Precision Laboratory had developed a readymade device.

Using the technology at the Laboratory and all the information from casts sent in, they developed a common proﬁle. The aim was to create a thin and durable device, which would complement foot wear.

During their research, the Laboratory found that many of the devices already in the marketplace oﬀered extrinsic rear foot posts with speciﬁc corrections. The Labs experience and research had shown that not every individual requires the same level of correction and so the PRECISION BLACK was designed with a deep heel cup to cradle the foot and an extended medial arch to provide support and balance needed in shoe gear.

The extended arch also helps to provide increased control to the mid-foot and helps to prevent pronation at the mid-tarsal joint. The PRECISION BLACK is very thin and because it doesn’t have an extrinsic rear foot post, fits neatly into most shoes and helps to provide a more tailor made shoe fit. It is very durable, isn’t affected by water and doesn’t compress. PRECISION BLACK can be used with or without top covers, making it ideal for use in runner’s shoes or other individuals where the shoe gear may get very wet. The PRECISION BLACK has sold over 30,000 pairs through Podiatrists in the USA. For the first time, this excellent device is now available in the UK.

Of course foot wear plays an important part in resolving a patient’s problems. Adrian was lucky to have been on the first NHS Orthopaedic Footwear Prescription Writing and Fitting Course held in the UK’s only dedicated foot wear centre at the Royal London Hospital and qualified as an Orthopaedic Foot Wear Consultant. In the next issue, we explore the benefits of custom foot wear, retail foot wear modifications and lacing techniques.

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40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 17

AWARENESS DAY

World Glaucoma Day - 12th March 2013

Anatomy of the Eye

What is glaucoma?

Glaucoma is the name for a group of eye conditions in which the optic nerve is damaged at the point where it leaves the eye. This nerve carries information from the light sensitive layer in the eye, the retina, to the brain where it is perceived as a picture. The eye needs a minimum pressure to keep the eyeball in shape so that it can work properly (usually in the region of 4 mm Hg). In some people, the damage is caused by raised eye pressure. Others may have an eye pressure within the statistically established ‘normal’ limits but damage occurs because there is a weakness in the optic nerve. In most cases both factors are involved but to a varying extent. In all cases, the aim of treatment for glaucoma is to reduce the level of pressure such that no further damage occurs

What controls pressure in the eye?

A layer of cells behind the iris produces a watery fluid, called aqueous. The fluid passes through a hole in the centre of the iris (called the pupil) to leave the eye through tiny drainage channels. These are in the angle between the front of the eye (the cornea) and the iris and return the fluid to the blood stream. Normally the fluid produced is balanced by the fluid draining out, but if it cannot escape, or too much is produced, then your eye pressure will rise. (The aqueous fluid has nothing to do with tears.) The Optic Nerve

Why can increased eye pressure be serious?

If the optic nerve comes under too much pressure then it can be injured. How much damage there is will depend on how much pressure there is and how long it has lasted, and whether there is a poor blood supply or other weakness of the optic nerve. A really high pressure will damage the optic nerve immediately. A lower level of pressure can cause damage more slowly, and then you would gradually lose your sight if it is not treated.

Are there different types of glaucoma? There are four main types.

Primary Open Angle Glaucoma (POAG) The most common is POAG in which the aqueous fluid can get to the drainage channels (open angle) but they slowly become blocked over many years. The eye pressure rises very slowly and there is no pain to show there is a problem, but the field of vision gradually becomes impaired.

Primary Angle Closure Glaucoma (PACG – Acute Glaucoma) PACG is much less common in western countries. This happens when there is a sudden and more complete blockage to the flow of aqueous fluid to the eye. This is because a narrow angle closes to prevent fluid ever getting to the drainage channels. This can be extremely painful and will cause permanent damage to your sight if not treated promptly. Secondary and developmental glaucoma There are two other main types of glaucoma. When a rise in eye pressure is caused by another eye condition this is called secondary glaucoma.

There is also a rare but potentially serious condition in babies called developmental or congenital glaucoma which is caused by malformation in the eye. This article is about chronic and acute glaucoma.

People Particularly at Risk

There are several factors, which increase the risk.

Age POAG becomes much more common with increasing age. It is uncommon below the age of 40 but affects one per cent of people over this age and five per cent over 65. Race Glaucoma is the leading cause of blindness among people of African Caribbean origin. It is six to eight times more common in African Caribbean people than in other races.

Family If you have a close relative who has POAG then you should have eye tests at intervals. You should advise other members of your family to do the same. This is especially important if you are aged over 40 when tests should be done every two years.

Short sight People with a high degree of short sight are more prone to POAG.

Diabetes Type II (diet or tablet controlled) diabetes has recently been shown to have a positive association in the development of POAG.

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40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 18

AWARENESS DAY Why can POAG be a serious risk to sight?

The danger with POAG is that your eye may seem perfectly normal. There is no pain and your eyesight will seem to be unchanged, but your vision is being damaged. Some people do seek advice because they notice that their sight is worse in one eye than the other. The early loss in the field of vision is usually in the shape of an arc a little above and/or below the centre when looking straight ahead . This blank area, if the glaucoma is untreated, spreads both outwards and inwards. The centre of the field is last affected so that eventually it becomes like looking through a long tube, so-called tunnel vision. In time even this sight would be lost. Structure of the Eye

What is PACG?

In PACG the pressure in the eye rises rapidly. This is because the periphery of the iris and the front of the eye (cornea) come into contact so that aqueous fluid is not able to reach the tiny drainage channels in the angle between them. This is sometimes called acute closed angle glaucoma.

Aqueous Flow in the Eye

What are the symptoms of PACG?

How is POAG detected?

Because glaucoma becomes much more common over the age of forty you should have eye tests at least every two years and ask for all three glaucoma tests. This has been shown to be much more effective in detecting glaucoma than just having one or two of the tests. These tests are: • viewing your optic nerve by shining a light from a special electric torch into your eye (ophthalmoscopy) • measuring the pressure in the eye using a special instrument (tonometry) • being shown a sequence of spots of light on a screen and asked to say which ones you can see. (Perimetry) All these tests are very straightforward, don't hurt and can be done by most high street optometrists (opticians).

How is POAG treated?

The main treatment for POAG aims to reduce the pressure in your eye. Some treatments also aim to improve the blood supply to the optic nerve. You will need to go to hospital for treatment and have regular check-ups afterwards. Treatment to lower the pressure is usually started with eye drops. These act by reducing the amount of fluid produced in the eye or by opening up the drainage channels so that excess liquid can drain away. If this does not help, your specialist may suggest either laser treatment or an operation called a trabeculectomy to improve the drainage of fluids from your eye. Your specialist will discuss with you, which is the best method in your particular case.

Can POAG be cured?

Although damage already done cannot be repaired, with early diagnosis, careful regular observation and treatment, damage can usually be kept to a minimum, and good vision can be enjoyed indefinitely. 16 | page

The sudden increase in eye pressure can be very painful. The affected eye becomes red, the sight deteriorates and may even black out. There may also be nausea and vomiting. In the early stages you may see misty rainbow coloured rings around white lights. Four Key Facts About Glaucoma • Glaucoma is a leading cause of blindness • Glaucoma can cause blindness if it is left untreated. Unfortunately approximately 10% of people with glaucoma who receive proper treatment still experience loss of vision. • There is no cure (yet) for glaucoma. Glaucoma is not curable, and vision lost cannot be regained. With medication and/or surgery, it is possible to halt further loss of vision. Since glaucoma is a chronic condition, it must be monitored for life. • Diagnosis is the first step to preserving your vision.

Everyone is at risk for glaucoma

Everyone is at risk for glaucoma from babies to senior citizens. Yes, older people are at a higher risk for glaucoma but babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in the United Kingdom).

Young adults can get glaucoma, too. People of African Caribbean origin in particular are susceptible at a younger age.

There may be no symptoms to warn you With open angle glaucoma, the most common form, there are virtually no symptoms. Usually, no pain is associated with increased eye pressure. Vision loss begins with peripheral or side vision. You may compensate for this unconsciously by turning your head to the side, and may not notice anything until significant vision is lost. The best way to protect your sight from glaucoma is to get tested. If you have glaucoma, treatment can begin immediately. International Glaucoma Association is the oldest and largest patient based glaucoma association in the world. It can provide a vast array of information about all forms of glaucoma, its detection and management and offers individual information and advice through its SightLine (0870 609 1870), by writing or through the IGA web site (www.glaucoma-association.com). With grateful thanks to David J. Wright, FIAM, FRSA Chief Executive, International Glaucoma Association.

40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 19

CONFERENCE

7th - 8th June 2013 Southport Theatre and Convention Centre The Promenade, Southport, Merseyside PR9 0DZ

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40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 20

A.G.M. Booking Form

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40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 21

A.G.M. Booking Form

FULL

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40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 22

CONFERENCE

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NICE recommends use of Lucentis for NHS treatment of vision loss The National Institute for Health and Clinical Excellence (NICE) has issued new guidance recommending that a potentially sight-saving drug should be made available on the NHS to people with diabetic macular oedema (DMO). The draft guidance recommends Lucentis (Ranibizumab), Novartis is used as a treatment for the eye condition and if the final guidance - expected to be published next month goes ahead, this treatment would become available on the NHS. At least 50,000 people in the UK could be affected by DMO, a serious eye condition which can lead to sight loss as a result of fluid leaking from the small blood vessels in the eye. Traditionally, laser treatment has been the standard treatment for DMO on the NHS, yet this only stops vision from deteriorating further. Lucentis, which is given in the form of an injection in the eye, is the first licensed treatment to improve vision in people with sight loss due to DMO. In 2011, NICE announced its original decision not to recommend Lucentis as a treatment for people with DMO. Diabetes UK, together with JDRF, the Macular Disease Society (MDS) and the Royal National Institute of Blind People (RNIB) appealed this decision, arguing that NICE failed to act fairly as key patient organisations and clinicians were not given the opportunity to comment on significant new evidence submitted by the drug manufacturer Novartis, which may have led to incorrect conclusions being drawn in NICE’s final decision. The decision from NICE comes after the drug’s manufacturer, Novartis, submitted a revised patient access scheme, together with analyses of updated effects of the drug for people with DMO. Barbara Young, Chief Executive of Diabetes UK, said, "We are delighted that NICE has reconsidered their previous decision, and that this draft guidance recommends that Lucentis is made available on the NHS. This would mean more people with diabetes would have a better opportunity to preserve and possibly improve their vision. We have campaigned vigorously alongside the RNIB, JDRF and the Macular Society for this outcome for the past two years and so welcome this result, and hope this is reflected in the final guidance when it is issued next month.”

INFORMATION

New campaign encourages us all to be "Food Smart"

To help people get smart this January, Change4Life is launching their Be Food Smart campaign, to show people how to recognise the foods that contain hidden sugar, salt and fat, and to ﬁnd healthier alternatives.

A new TV ad warns people that consuming too many "hidden nasties" in some foods can lead to Type 2 diabetes, heart disease, stroke and cancer. The new campaign gives people the tools and information they need – including new tips, advice and recipes – to help them eat more healthily and develop "Food Smart" habits. Be Food Smart

The Be Food Smart launch comes at a time of year when we often have good intentions to start eating healthily, and the great news is that this year we don’t have to stop enjoying family favourites to do so. Finding tasty, cheaper and healthier alternatives to popular meals and take-aways is easy – you just need to learn how to be a bit food smart. Meal Mixer

To get everyone started, Change4Life is giving away a free Meal Mixer, a healthier recipe tool for the whole family, to all those who sign-up. Packed with ideas and tasty recipes for food smart breakfasts, lunches and evening meals, the Meal Mixer makes it easy to make healthier choices every day. The Mixer allows you to view almost 700 diﬀerent meal combinations, giving you nearly two years' worth of healthier meals each day, and comes with special oﬀers on food. Food Smart IQ Quiz

Change4Life has developed an interactive Food IQ Quiz so that people can test their knowledge of the hidden nasties that are often found in their favourite foods. Take the Food IQ Quiz. Smartphone app

In addition, so that our busy lifestyles don’t get in the way of healthy eating, there’s a new free Be Food Smart healthier recipe smartphone app, containing more than 120 meal ideas. The app can be used to plan out daily meals for the whole family and even create a shopping list, which makes it even easier to cook healthier and tastier meals on a budget. page | 21

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INFORMATION "Making informed choices"

Cathy Moulton, Clinical Advisor at Diabetes UK, said, "Whether you have Type 1 or Type 2 diabetes, balancing your diet can be challenging. Making sensible food choices and adapting eating habits are really important in managing the condition and protecting your long-term health. "No food is forbidden, but making informed choices is not always easy. The good news is that you should still be able to enjoy a wide variety of food with more peace of mind, because you have increased your understanding about what you choose to eat." Further information

Go to the Change4Life site to sign up and receive your Meal Mixer – along with recipes, tips and advice on healthier meal choices – or to download the app.

UK has world’s 5th highest rate of Type 1 diabetes in children

The UK has the world’s ﬁfth highest rate of Type 1 diagnosis in children aged up to 14, according to a new international league table compiled by Diabetes UK.

The league table, based on estimates from the International Diabetes Federation, shows that 24.5 per 100,000 children aged 0 to 14 in the UK are diagnosed with the condition every year. Of all the countries with data, only Finland, Sweden, Saudi Arabia and Norway have higher rates. The rate in the UK is over double that in France (12.2) and Italy (12.1). In Papua New Guinea and Venezuela, which have the joint lowest reported rates in the world, just 0.1 per 100,000 develop the condition a year. Type 1 not linked to obesity or lifestyle

Scientists do not fully understand why there is such wide variation but genetics is thought to play a role. What we do know is that, unlike Type 2 diabetes, Type 1 is not linked to obesity or lifestyle.

According to Diabetes UK, the UK’s high incidence of Type 1 diabetes in children means it is especially important that people are aware of the symptoms. Type 1 diabetes can lead to serious illness, and even death, if it is not diagnosed quickly. The 4 Ts of Type 1 diabetes symptoms

Just nine per cent of parents are currently aware of the 4 Ts of Type 1 diabetes symptoms: Toilet; Thirsty; Tired; and Thinner. This is one of the main reasons a quarter of the 2,000 children a year who develop diabetes are only diagnosed once they are already seriously ill. We are campaigning to increase understanding that frequent urination, excessive thirst, extreme tiredness and

22 | page

unexplained weight loss are all symptoms. We also want to ensure parents and carers understand that if a child has any of these symptoms then they need to take them to their GP urgently and insist on a test for Type 1 diabetes. Good-quality healthcare

The UK’s high position in the league table should also highlight the need for good-quality healthcare for children with diabetes. Yet just six per cent of children with the condition are currently recorded as getting the eight checks recommended by the National Institute for Health and Clinical Excellence. Less than a sixth (15 per cent of boys and 16 per cent of girls) are achieving recommended blood glucose levels. "Parents should know the symptoms"

Barbara Young, Chief Executive of Diabetes UK, said, "We do not fully understand why more children in the UK are developing Type 1 diabetes than almost anywhere else in the world. But the fact that the rate is so high here in the UK means it is especially important that parents know the symptoms. Raise awareness

"At the moment, poor understanding of Type 1 diabetes symptoms is one of the main reasons that far too many children are already seriously ill by the time they are diagnosed, and this is why we need to raise awareness that Toilet, Thirsty, Tired, and Thinner are all symptoms. Parents and carers also need to understand that if a child has any of these symptoms then they need to see a doctor urgently and be tested for Type 1 diabetes. Lost in the system

"The fact that the UK has a relatively high number of children developing Type 1 diabetes also means it is vital that we are able to offer first-class healthcare once children are diagnosed. Too many children are not getting the recommended checks and have high blood glucose levels, while another big issue is that young people are also being lost in the system when the time comes to transfer from paediatric to adult services. "Type 1 diabetes is a serious condition that can lead to devastating complications and early death if not managed properly. This is why children with Type 1 diabetes need to set off on the right path in terms of managing their condition well, right from the beginning. It is a tragedy that all too often this is not happening." Further information; go to www.diabetes.org.uk

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TOUCH THE TOES

TEST

About the test

Reference guide

Step-by-step instruction

Recording the results

What the results mean and what to do

REFERENCE GUIDE

ABOUT THE TEST A The Touch the toes test* is quick and easy, designed to assess sensitivity in your feet, and can be done in the comfort of your own home. Why is sensitivity important? Sensitivity is an important way that the body can alert you to other problems. Sensations, like sharp pain or throbbing, can tell you when you may have damage to a part of your body. In the case of feet, pain could be due to a burn, blister or cut and because you feel it you can take prompt action and appropriate treatment. If sensation is impaired you may not realise if minor damage has occurred and left unknown and untreated the risk of infection is increased. Infections and ulcers are also painful – but not if that part of the foot also lacks sensation.

6 4

Knowing if you have impaired sensitivity requires you to rely more on regular visual checking for discoloration or swelling for instance. It is important to remember that impaired sensation itself does not cause infection and ulceration. Please note that the Touch the toes test is not a substitute for your annual foot review by an appropriately trained person.

Subject’s right foot, your left side

Subject’s left foot, your right side

1 *Officially known as the Ipswich Touch Test which was designed by Gerry Rayman and the team at Ipswich Hospital page | 23

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STEP-BY-STEP INSTRUCTION HOW TO PERFORM THE TEST The test simply involves very lightly touching six toes, three on each foot as shown to find out how many of the touches are felt. Importantly the touch must be gentle, light as a feather and brief.

VERY IMPORTANT! •

The touch must be light as a feather, and br ief (1– 2 seconds): do not pr ess, pr od or poke tap or stroke the skin.

• If the per son did not r espond do not attempt to get a re a ction by pr essing har d er. They did not feel; this should be r ecor ded as not felt. • You must not touch each toe mor e than once. If not felt do not r epeat the touch , ther e is no second chance. 1

Remove socks and shoes and rest the subject with their feet laying on a sofa or bed.

Remind them which is their RIGHT and LEFT leg, pointing this out by firmly touching each leg, saying “ this is your right” when the right leg is touched and “ this is your left side” when the left is touched. If you face the soles of their feet their right is on your left (see reference guide, page 1).

3 4

Ask them to close their eyes and keep them closed until the end of the test.

Inform them that you are going to touch their toes and ask them to say right or left as soon as they feel the touch and depending on which foot was touched.

Perform the touch, using your index (pointing finger) as shown in the photos and diagrams.

The pictures also show which six toes should be touched and the sequence.

So, start by lightly touching the tip of the toe marked 1 (right big toe) with the tip of your index finger. The patient will respond by saying “ right” if they feel the touch.

Record the result by circling ‘Y’ on the attached record sheet. If they did not respond, circle ‘N’.

Now move to the toe marked 2, the right little toe, record the result, followed by the toe marked 3, the left big toe etc.

10 Continue until all the six toes has been checked. 24 | page

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RECORDING THE RESULTS

Y N

REMINDER

N 1

Using the index finger, touch the tips of toes following the sequence from 1 to 6 shown in photos and drawings shown on page 2.

The touch must be light as a feather , and very brief (1–2 seconds): DO NOT press, prod or poke. Remember: If the touch has not been felt do not press harder, and DO NOT try again. You can only touch each toe ONCE; if not felt this must be recorded by circling ‘N’ on the diagram right. There is no second chance. If the subject correctly says right or left, circle ‘Y’ on the diagram right.

WHAT THE RESULTS MEAN AND WHAT TO DO NORMAL SENSATION If you felt the touch at all six or five of the six toes, as shown in the example below, then your sensation is normal and you are not at increased risk of developing a foot problem because of lack of sensation. However, you must continue having the more detailed foot checks that you should be receiving annually. Y

Y N

N 5

L Y

N N

6 4

If you did not feel when touched at two or more of the six toes, as shown in the examples below, then you are very likely to have reduced sensation and may be at risk of a diabetic foot ulcer. This needs to be confirmed by further testing. We suggest you visit your surgery and ask for a full examination of your feet. After that examination you should ask for the results of the assessment and then if it is abnormal you should be referred to a diabetes specialist podiatrist, foot protection team, or the diabetes foot clinic depending on the severity.

Y N

N 5

6 4

R Y

N 1

IMPAIRED SENSATION

Y N

Subject’s left foot, your right side

Subject’s right foot, your left side

Y N

N 5

6 4

L page | 25

40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 28

INFORMATION

Do Epilepsy and Migraine share a genetic link? Having two or more relatives with epilepsy raises risk of migraine “Epilepsy and migraine ‘could have a shared genetic link’”, reports BBC News.

This headline is based on a study of people with epilepsy who also had two or more close relatives with epilepsy.

Researchers were interested in whether having this type of family history increased the risk of participants experiencing migraines. If this was the case, it would suggest that epilepsy and migraines may have ‘shared genetic effects’. The study found that participants with two or more first-degree relatives (parents, siblings or children) with epilepsy were more likely to suffer from migraine with aura (where the headache is preceded by warning signs such as visual problems), than participants with fewer additional affected relatives.

Overall, this study does not clarify whether there is a deﬁnite genetic link between epilepsy and migraine, it can only indicate an association in some groups of people. The study was carried out by researchers from Colombia University in New York. It was funded by the US National Institute of Neurological Disorders and Stroke. The study was published in the peer-reviewed journal, Epilepsia.

This story was well-reported by the BBC, although it did not comment on the methods of this study or their limitations. This was a cohort study that aimed to determine whether there was a link between whether a person had a confirmed diagnosis of either generalised epilepsy (where a person loses consciousness during a seizure) or focal epilepsy (where a person does not lose consciousness during a seizure), and: • the number of first-degree relatives who also had history of epilepsy or seizures (fits)

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• the likelihood that the individual with epilepsy and a family history as described above also suﬀered from migraines

By seeing if individuals who have a greater number of family members affected by epilepsy (suggesting they may have genetic susceptibility) are more likely to suffer from migraines, the researchers aimed to strengthen the evidence for a genetic link between epilepsy and migraine. Previous research into a possible link has produced inconclusive results – some studies found evidence of a link, others report finding no evidence. What did the research involve?

The researchers recruited 730 participants aged 12 years or older with either focal or generalised epilepsy from 501 families containing two or more individuals with epilepsy of unknown cause. This meant that at least two siblings or a parent-child pair had to have epilepsy. Participants were asked about their history of migraine using a standardised interview, and participants were classiﬁed as having had: • no migraines

• migraine without aura

• any occurrence of a migraine with aura (where the headache is preceded by warning signs such as visual problems including flashing lights or blind spots) The researchers then asked participants about additional relatives affected with epilepsy or a seizure disorder. For each family, the researchers calculated the total number of relatives affected beyond the enrolled participants (referred to as ‘additional’ affected relatives) and the number of first-degree relatives of participants who were affected. The researchers looked to see if a history of seizures in additional relatives increased the likelihood of migraine. The researchers controlled for age, sex, participant type

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INFORMATION (for example, whether the participant was the ﬁrst enrolled person, a sibling or a parent), and epilepsy type (focal epilepsy or generalised epilepsy). What were the basic results?

The prevalence of migraine in all participants was 25.2%. Women were more likely to have had a migraine than men: 31.5% of women had had a migraine, compared to 14.5% of men (odds ratio 2.4, 95% conﬁdence interval 1.62 to 3.52).

The prevalence of migraine with aura increased when individuals had two or more additional ﬁrst degree relatives with seizure disorder not enrolled in the study: • 10% of patients with no additional relatives with seizure disorder had migraine with aura

• 11.3% of patients with one additional relative had migraine with aura

• 25% of patients with at least two additional relatives had migraine with aura

This meant that the odds of having a history of migraine with aura were 2.5 times higher if an individual had at least two additional relatives with a seizure disorder. However, if more distant relatives were included, the association between number of aﬀected relatives and migraine disappeared.

The prevalence of the other type of migraine, migraine without aura, did not vary with the number of additional ﬁrst-degree relatives with seizure disorder. How did the researchers interpret the results?

The researchers concluded that the “prevalence of a history of migraine with aura (but not migraine without aura) was significantly increased in enrolled participants with two or more additional affected first-degree relatives.” They go on to say that, “these findings support the hypothesis of a shared genetic susceptibility to epilepsy and migraine with aura.” Conclusion

This paper suggests there is a link between the number of close relatives with a seizure disorder and the

likelihood that an individual with epilepsy will also suﬀer from migraines with aura.

However, it seems that the researchers were only interested in what they term ‘additional’ family members, and did not take into account the fact that to be eligible for this study at least two siblings or a parent and child both had to suffer from epilepsy. There seems to be the possibility that if, for example, four members of a family were enrolled in the study but the family had no further affected members, all members of this family would be classified as having no additional family members with seizure disorders. It is unclear what would have been the effect on the results if only one member of each family had been studied and all other members of the family had been considered as relatives with seizure disorder. The authors also identify limitations to their study:

• They did not collect data on family size. They consider that it is possible that families with more participants affected by seizure disorder may be larger, and that this is influencing the results. However, suffering from migraine might be independent of family size, and therefore this should not affect the results.

• The presence of seizure disorders in additional relatives was not conﬁrmed, and the researchers were not able to assess the history of migraine in non-enrolled family members. Overall, this study does not clarify whether there is a deﬁnite genetic link between epilepsy and migraine.

Though it does suggest an association, in some families at least, which would seem to make the case for further research. Learning more about the genetics of both epilepsy and migraines could eventually lead to a therapeutic breakthrough.

The IOCP would like to thank NHS direct for providing the above information More details http://www.nhs.uk/Pages/HomePage.aspx

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BRANCH PROFILE

Wolverhampton Branch

A Message from your Secretary

We are a small friendly branch of about 20 members, having at least half attend every meeting. We have a loyal core base that attends showing their support for the branch and taking part in branch activities. As we all know this can be an isolating and lonely profession at times so attending the meetings gives us all a chance to exchange ideas and points of view. We hold our meetings four times a year on a Sunday morning at a branch memberâ&#x20AC;&#x2122;s surgery that she kindly lets us use; this keeps the branch expenditure down so helping keep the branch viable. Many of our branch members have been attending meetings for over 30 years and have seen lots of changes in the profession, some for the better and some not so and have made some lifelong friends. Some are old Scholl girls that could tell a tale or two but they wouldnâ&#x20AC;&#x2122;t be printable in this profile! We try to make our meetings as varied and interesting as possible, asking our members at the Branch A.G.M. what topics they would like to cover over the coming 28| page

year and doing our best to arrange speakers and workshops for them. As a branch we are very proactive in keeping our cpd file updated as you never know when it could be your turn to be called upon, but Iâ&#x20AC;&#x2122;m quite sure we would all pull together to help a fellow member get through it . The Institute seems to be a lot more driven and academic these days which can only be a good thing as the profession is evolving at such a fast pace we all need to try to keep up and support each other. We have a branch library where we can sign books out to help with course work we may be doing or just as a refresher to sharpen our skills. Lastly I would like to thank our branch members that attend for making our branch fun and enjoyable as without them we would not have a branch. David Collett Branch secretary

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BRANCH PROFILE

Leeds Bradford Branch Profile

It is now two years since the previously separate Leeds and Bradford branches merged to form which I think is now the largest branch in the Institute. Since we had always held joint meetings at the same venue, very little changed for the members. It simplified our branch A.G.M.s and reduced the number of branch officers needed.

To keep in contact with all our members we are gradually getting email addresses so we can let them know dates of meetings and speakers etc. If you are a Leeds/Bradford member and I donâ&#x20AC;&#x2122;t have yours my phone number is on the National Officers page at the back of the Review). We meet on the first Sunday morning in the month from October to June and as often as possible we have a speaker. This month we had a talk on dementia, given by one of the Admiral Nurses. Next month is a first aid update course. It helps attendance so much where there is more than just a business meeting.

The December meeting always ends with many of us going out for a Christmas lunch together.

I think the branch structure of the Institute is one of its great strengths. Without it, especially in private practice, you can soon feel as if you are working in isolation. Contact with others in the profession is most important. Norman Hodge Leeds Branch Secretary

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BRANCH NEWS

Chris Maggs - City and Guilds Award of Merit Presentation Monday 18th October found me and our acting Chairperson, Colette Johnson, on our way to Sheffieldâ&#x20AC;&#x2122;s branch meeting at the SWD sports club in Sheffield. What we did not realise at the time was that it was going to take us four and half hours to get

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there!!! But get there we did at just before 9:30pm just as the meeting was being brought to a close. We were made very welcome by Penny and Debora, and given a cup of very much appreciated coffee to make a quick recovery before the reason for our journey. The reason for our journey was to present the C&G award of merit to Christopher Maggs. Chris has excelled in his written and practical work whilst completing the C&G course in Foot Health care run by the Institute of Chiropodists and Podiatrist. This is a great honour for Chris and the IOCP that C&G has recognised that one of our students has achieved such a high level of competence within this field. Presentation of the medal for the Award of Merit was made to Chris by the Chairperson of the Institute Mrs Colette Johnson. I would like to say on a personal note that I wish Chris the best of success in his new chosen career and hope that he gains as many friends and as much pleasure from his career as I have done over the years. Good luck for the Future Chris. Malcolm Holmes (Acting Vice Chairman)

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Meningitis Trust Coﬀee Break

MENINGITIS NEWS

is one of the biggest fundraising events for the Meningitis Trust and helps us to raise vital funds to support everyone whose lives have been affected by meningitis. By arranging this easy-to-organise, fun event you are helping us to make a difference to people whose lives have been affected by meningitis.

A Coﬀee Break is the perfect way to show your support, generate awareness of meningitis and raise funds all at the same time. Key facts about viral meningitis

• Many thousands of cases occur each year, mostly aﬀecting babies and toddlers. • Although most people will make a full recovery, some are left with serious and debilitating meningitis after-eﬀects.

• Viral meningitis after-effects can include headaches, exhaustion and memory loss. • The recovery process from viral meningitis can be very slow, the majority of sufferers no longer experience after-effects 12 months after their illness. • The symptoms of viral meningitis can be very similar to those of bacterial meningitis, so it is essential to seek urgent medical help if concerned. Key facts about Bacterial meningitis

• 2,500 cases of bacterial meningitis are reported in the UK every year.

• Meningitis caused by bacteria can be lifethreatening and needs urgent medical attention. • Some bacteria that cause meningitis can also cause septicemia.

• Most people who suﬀer from bacterial meningitis recover, but many can be left with a variety of aftereﬀects. • One in ten people who contract bacterial meningitis will die.

Organising your Coffee Break Getting Started

This is such a fun event. It can grow in all kinds of ways and before you know it you have a party on your hands: • Some people add biscuits and cake, even lunch! • Get the kids involved by playing games or face painting. • At work you could pledge to double your donation if your boss serves the brew, or ask your company to match what you raise, pound for pound! You can hold your event at any time to suit you, but it could be a chance to celebrate the start of Spring, something to do over half term holiday. Register for the Meningitis Trust Coffee Break and you will be sent a free event pack. It includes event invites, posters and fun-filled fundraising ideas. All you have to do is register http://www.meningitis-trust.org/fundraising/ events/coffee-break/registration/ • There is no vaccine to protect against all strains of meningitis. • Knowing the signs and symptoms of the disease, trusting your instincts and getting urgent medical help is the best way to protect yourself and others. Key facts Meningococcal Disease • There are approximately 1500 reported cases of meningococcal disease each year in the UK. This is the most common cause of bacterial meningitis page | 31

40025 Chiropody Mar-Apr 2013 12/02/2013 09:12 Page 34

MENINGITIS NEWS • Group B accounts for at least 90% of cases of meningococcal disease.

• Most people will make a good recovery, but meningococcal disease can cause very severe illness that can rapidly result in death and leave people with severe after-eﬀects.

• Around 7% of cases of meningococcal disease will result in death.

Of those who survive, 15% can be left with severe and disabling after-eﬀects such as loss of hearing and sight, brain damage and, where septicemia has occurred, damage to major organs, loss or digits and limbs.

• Septicemia is generally more life-threatening than meningitis.

• Meningococcal disease can strike at any age, but most cases occur in babies and young children, the next most vulnerable group is teenagers and young adults Key facts pneumococcal meningitis

• In 2008, there were around 200 reported cases of pneumococcal meningitis in the UK. • Most cases occur in babies and young children under 18 months of age. • Approximately 15% of cases will result in death.

• Most people will make a good recovery, but pneumococcal meningitis requires quick medical treatment. • 25% of those who survive pneumococcal meningitis can be left with severe and disabling after-eﬀects. • There are routine vaccines available to help prevent pneumococcal disease in the UK. Key facts Hib meningitis

• A routine vaccine is available to prevent Hib disease. • Each year there are around 30 cases of Hib meningitis in the UK.

• Most people make a good recovery, but around 3% will die.

• 3 – 5% of survivors will suﬀer severe after-eﬀects, such as deafness and long-term neurological complications. 32 | page

Key facts TB meningitis • There are 200 cases of TB meningitis reported each year in the UK • TB meningitis usually develops slowly. • TB infection usually begins in the lungs and in about 2% of cases the infection can progress to TB meningitis. • Anyone can get TB and therefore TB meningitis, but it is more likely to affect those living in poor conditions, such as the homeless, and those with other illnesses, especially HIV infections. • At least 20% will suffer long-term after-effects. These are often severe and may include severe brain damage, epilepsy, paralysis and hearing loss. • Tragically, between 15-30% of patients will die despite receiving treatment and care.

Key facts neonatal meningitis Neonatal meningitis occurs in babies under one month old. There are diﬀerent causes of neonatal meningitis, but the most common are bacteria called group B streptococcus (GBS), followed by Escherichia coli (E. coli) and listeria. When infection occurs within the ﬁrst week of life, it’s called ‘early onset’ and will more commonly cause septicemia. After one week of life, it is called ‘late onset’ and meningitis can be more typical. • Neonatal meningitis is rare. • Unfortunately the death rate from neonatal meningitis can be as high as 20%. • As many as 50% of babies making a recovery from neonatal meningitis will be left with a disability. For further information visit http://www.meningitis-trust.org/meningitis-info/

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! ! ! ! ! ! !! !! ! !

! !

2013 Annual General Meeting Nominations for National Oﬃce

! ! ! !

President –)Two )) ) Nominations )) )) )) ) ) ) ) ) ) ) ) )))))))))1-2#")3#'"4) )))))))))1-2#")3#'"4) Roger Henry

) ) 5 5 and ) ) Cornwall ) ) ) Branch ) ) )) ) Devon

) ) ) )

) ) ) Chairman Executive Committee ))))))))))))))A'#).-/%'0(%-') One Nomination

) ) ) )

) ) ) ) 506%&)7"#,) 506%&)7"#,) David Crew )))))))))))))))) )))))))))))))))) <Surrey < ) ) and ) ) Berkshire ) ) Branch ) )

) Board ) ) of Education ) Chairman ) Nomination ) One

Colette Johnston

Robert Sullivan

Northern Ireland Branch

Republic of Ireland Branch

)

) Treasurer ) Hon. ) Nomination ) One

) Board ) ) of Ethics ) Chairman, ) Nomination ) One

Jacquie Drane

Julie Dillon

West of Scotland Branch !

) ) ) ) Vice Chairman -)Executive Committee ) ) One Nomination Alisdair Reid

West of Scotland Branch

Leeds Bradford Branch

))

)

) )

Vice Chairman, Board of Education One Nomination

) )

)

Joanne Casey

Republic of Ireland Branch

) ) ) ) ) ) ) ) ) ) ) ) to be ) Standing ) Orders Committee ) ) ) – Two Nominations ) ) ) – Two ) Persons ) ) ) elected

)

! ! ! ! !

)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))

! !

)

Martin Hogarth Linda Pearson ))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) ) Leeds Bradford Branch

Western Branch

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)

40025 Chiropody Mar-Apr 2013 12/02/2013 09:13 Page 36

CLASSIFIED To advertise in this section and on our website Call 01704 546141 or email bernie@iocp.org.uk

TORQUAY, DEVON - RETIREMENT SALE

Surgery and Domiciliary Established 25 years Income £17k over 3 days. Plenty of Scope for Expansion. Price £15K Telephone 01803 211616

WANTED

Domiciliary Podiatry Business Podiatrist seeks business opportunity. Any location considered. Telephone 01292 475302 vcameronﬁddes@gmail.com

NORTH EAST DERBYSHIRE PRACTICE

A great opportunity has arisen to buy an established podiatry business of 8 years Located in a beautiful stone built shopping centre in a picturesque town. The clinic has good aspect and ample parking, has 2 treatment rooms reception/waiting area, kitchen with storage. Podiatry business consists of 3 day clinic work and 1 day dom per week. Great potential for expansion. Sale due to relocation. Price negotiable. Telephone 07979 150308

EQUIPMENT/SUPPLIES FOR SALE Podospray Work Unit for sale incorporating air/water spray and spray drill, three storage drawers and instrument tray with ultra violet light. Cost £3600. Will accept oﬀers around £950. Can arrange delivery anywhere in the UK. Also Daray examination mobile light. Cost £950. Will accept £350. In new condition. Sale due to retirement.

Telephone: 07736 814281 for further details.

Classiﬁed Section SOUTH LINCOLNSHIRE

Three bedroom detached house with integral surgery for sale - London - 55 Minutes by rail - will consider selling separately. Lovely historic market town in one of the best areas of the country. Lots of beneﬁts including one of the best Grammar schools in the country. Established over 30 years. 20,000 population unopposed.

Sale to include all equipment (if required) - ready to walk in and start! Wonderful opportunity - Further details. 01778 426101 - Sale due to retirement

West Midlands Area

Business for Sale - Wolverhampton, West Midlands. Attractive practice, with contents, on-going. Turnover in excess of £40,000 per annum. Reasonable oﬀers considered. Please contact Thomas on the following email: hypernano21@gmail.com. Please leave your name, telephone number and personal circumstances and we will contact you.

Chiromart UK “WHY PAY MORE?”

Suppliers of Autoclaves and Chiropody Surgery Equipment. Single Items to full surgery set-ups. Quality used and new. Also your equipment wanted. Surgery clearances, trade-ins and part exchange CASH WAITING… www.chiromart.co.uk Tel: 01424 731432 (please quote ref: iocp

DES CURRIE INTERNATIONAL (+44) (0) 1207 505191

Business Cards 1 sided; 1,000 - £40 /10,000 - £99 Record Cards/Continuations/Sleeves (8” x 5”) 1,000 - £68 Appointment Cards 2 sided; 10,000 - £99 Small Receipts 2,000 - £49; 4,000 - £71 Flyers 10,000 - £82 + type setting + carriage FOR ALL YOUR STATIONERY NEEDS

34 | page

40025 Chiropody Mar-Apr 2013 12/02/2013 09:13 Page 37

NATIONAL OFFICERS

National Officers Acting President

Mr. R. Sullivan, BSc.(Hons) Podiatry, MSc. Pod Surg,. Pg,Dip., M.Acu,.FSSChP. FIChPA. M.Inst.Ch.P

Acting Chairman Executive Committee Mrs. C. Johnston, M.Inst.Ch.P., BSc.(Hons)

Acting Vice-Chairman Executive Committee Mr. M. J. Holmes, BSc. (Hons) M.Inst.Ch.P.

Chairman Board of Ethics

Mrs. C. Johnston, M.Inst.Ch.P., BSc.(Hons)

Chairman Board of Education

Mr. R. Sullivan, BSc.(Hons) Podiatry, MSc. Pod Surg,. Pg,Dip., M.Acu,.FSSChP. FIChPA. M.Inst.Ch.P

Acting Vice-Chairman Board of Education Miss Joanne Casey, M.InstCh.P., BSc.

Honorary Treasurer Mrs. J. Drane, M.Inst.Ch.P.

Standing Orders Committee

Mr. M. Hogarth, M.Inst.Ch.P. Mrs L. Pearson, M.Inst.Ch.P., BSc., Pod Med

Secretary

Area Council Executive Delegates Miss A. J. Burnett-Hurst

Midland Area Council

National Officers Area Council Executive Delegates Branch Secretaries

Branch Secretaries Birmingham

Mrs. J. Cowley

01905 454116

Devon & Cornwall

Mrs. M. Reay

01805 603297

Cheshire North Wales

Mrs. D. Willis

0151 327 6113

East Anglia

Mrs. Z. Sharman

01473 830217

Hants and Dorset

Mrs. J. Doble

01202 425568

Essex

Mrs. B. Wright

01702460890

Leeds/Bradford

Mr. N. Hodge

London

Mrs. F. Tenywa

0208 586 9542

North of Scotland

Mrs. S. Gray

01382 532247

Leicester & Northants North East

North West

Northern Ireland Central

Mrs. S. J. Foster

Mrs. E. Barwick

01924 475338 01234 851182

0191 490 1234

Mr. B. Massey

0161 486 9234

Mrs. P. McDonnell

028 9062 7414

Mrs. V. Dunsworth, M.Inst.Ch.P., DChM

Nottingham

Mrs. V. Dunsworth

0115 931 3492

Mrs. M. Allison, M.Inst.Ch.P.

South Wales & Monmouth

Mrs. E. Danahar

01656 740772

North West Area Council

Republic of Ireland Area Council Mrs. J. Casey, M.Inst.Ch.P. BSc.

Scottish Area Council Mr. A. Reid, M.Inst.Ch.P

Southern Area Council

Mr. D. Crew, OStJ, F.Inst.Ch.P., DChM, CertEd

Yorkshire Area Council Mrs. J. Dillon, M.Inst.Ch.P.

Sheffield

Surrey and Berkshire

Mrs. D. Straw

Mrs. M. Macdonald

01623 452711

0208 660 2822

Sussex

Mrs. V. Probert-Broster

01273 890570

Western

Mrs. L. Pearson

01745 331827

West of Scotland

Mr. S. Gourlay

0141 632 3283

Teesside

West Middlesex Wolverhampton

Mr. J. Olivier

Mrs. H. Tyrrell Mr. D. Collett

01287 639042 0208 903 6544 0121 378 2888

page | 35

40025 Chiropody Mar-Apr 2013 12/02/2013 09:13 Page 38

DIARY

What’s on in your area?

March 2013 3

East Anglia Branch A.G.M. 10 a.m. Barrow Village Hall, Bury St Edmunds, IP29 5AP Tel: 01473 830217 Leeds/Bradford Branch Meeting 10 a.m. Oakwell Motel, Low Lane, Birstall, WF17 9HD Tel: 01924 475338

11 West Middlesex Branch Meeting 8 p.m. The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544

13 Hants and Dorset Branch Meeting 7.45 p.m. Crosfield Hall, Broadwater Road, Romsey SO51 8GL Tel: 01202 425568 South Wales and Monmouth Branch Meeting 2 p.m. Village Hall, Coryton, Cardiff Tel: 01656 740772

18 Surrey and Berkshire Branch Meeting 7.30 p.m. This meeting includes CPD. Pirbright Village Hall, Pirbright, Surrey Tel: 0208 660 2822 19 North West Branch Meeting 7.00 p.m. St Joseph’s Parish Centre, Harpers Lane, Chorley, Lancs Includes CPD presentation Tel: 0161 486 9234

21 Sheffield Branch Meeting 7.30 p.m. SWD Sports Club, Heeley Bank Road, Sheffield S2 3GL Tel: 01623 452711 24 Cheshire North Wales, Staffs and Shropshire Branch meeting 10 a.m. Doppler use and Trade Stand. The Dene Hotel, Hoole Road, Chester Tel: 0151 327 6113

April 2013

11 Birmingham Branch Meeting 8 p.m. British Red Cross Centre, Evesham, Worcs. Tel: 01905 454116

14 Essex Branch Meeting 2 p.m. Southend University Hospital Education Centre Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890 14 Western Branch Meeting 12.15 p.m. Blair Bell Education Centre, Liverpool Women’s Hospital, Crown Street, Liverpool. Presentation: How to Survive HPC audit. Trade Representation; Canonbury – plus raffle Further details: 01745 331827

21 Nottingham Branch Meeting Feet and Co Ltd. West Bridgford, Nottingham NG1 6EN Tel: 0115 931 3492 36 | page

28 Western of Scotland Branch Meeting 11 a.m. Express by Holiday Inn, Springkerse Business Park, Stirling, FK7 7XE Tel: 0141 632 3283

May 2013

12 Wolverhampton Branch Meeting 9.30 am 4 Selman’s Parade, Selman’s Hill, Bloxwich, Walsall, WV3 3RN Tel: 0121 378 2888 13 West Middlesex Branch Meeting 8 p.m. The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544 19 Cheshire North Wales, Staffs and Shropshire Branch Meeting 10 a.m. The Dene Hotel, Hoole Road, Chester Tel: 0151 327 6113

June 2013 3

Wolverhampton Branch Meeting 9.30 am 4 Selman’s Parade, Selman’s Hill, Bloxwich, Walsall, WV3 3RN Tel: 0121 378 2888 – Date to be Confirmed

Surrey and Berkshire Branch Meeting 7.30 p.m. Pirbright Village Hall, Pirbright, Surrey Tel: 0208 660 2822

7th - 9th National Podiatry Conference Southport Theatre and Convention Centre, The Promenade, Southport Tel: 01704 546141 for further details 9

North West Branch Seminar Day 10 a.m. Biomechanics Training. Venue to be advised Tel: 0161 486 9234

11 Birmingham Branch Meeting 8 p.m. British Red Cross Centre Evesham, Worcs. Tel: 01905 454116

19 Hants and Dorset Branch Meeting 7.45 p.m. Crosfield Hall, Broadwater Road, Romsey SO51 8GL Tel: 01202 425568 23 Essex Branch Meeting 2 p.m. Southend University Hospital Education Centre Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890

40025 Chiropody Mar-Apr 2013 12/02/2013 09:13 Page 39

DIARY 23 Western Branch Meeting 12.15 p.m. Blair Bell Education Centre, Liverpool Women’s Hospital, Crown Street, Liverpool. Presentation TBC plus trade stand and raffle. Further details: 01745 331827

July 2013 6 8

Surrey and Berkshire Branch Meeting 1.30 p.m. Greyfriars Centre, Reading Berkshire Tel: 0208 660 2822

West Middlesex Branch Meeting 8 p.m. The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544

September 2013 1 9

Western of Scotland Branch Meeting 10 a.m. Express by Holiday Inn, Springkerse Business Park, Stirling, FK7 7XE Tel: 0141 632 3283 West Middlesex Branch Meeting 8 p.m. The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544

17 North West Branch Meeting 7.00 p.m. Includes CPD Presentation. St Joseph’s Parish Centre, Harpers Lane, Chorley, Lancs Tel: 0161 486 9234

20 Birmingham Branch Meeting 8 p.m. British Red Cross Centre Evesham, Worcs. Tel: 01905 454116 21 South Wales and Monmouth Branch 10 a.m Full Day First Aid Course. Penath Sea Cadets Unit, Stanwell Crescent, Penarth, CF64 1DF - £65 (discount of £10 before 17th March) Tel: 01656 740772

22 Western Branch Meeting 12.15 p.m. Blair Bell Education Centre, Liverpool Women’s Hospital, Crown Street, Liverpool. Presentation: “Tissue viability” and trade stand. Further details: 01745 331827

29 Essex Branch Meeting 2 p.m. Southend University Hospital Education Centre Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890

29 Nottingham Branch Meeting Feet and Co Ltd. West Bridgford, Nottingham NG1 6EN Tel: 0115 931 3492

October 2013 2

Hants and Dorset Branch Meeting 7.45 p.m. Crosfield Hall, Broadwater Road, Romsey SO51 8GL Tel: 01202 425568

Cheshire North Wales, Staffs and Shropshire Branch meeting 10 a.m. The Dene Hotel, Hoole Road, Chester Tel: 0151 327 6113

Surrey and Berkshire Branch Meeting 7.30 p.m. Pirbright Village Hall, Pirbright, Surrey Tel: 0208 660 2822

27 Wolverhampton Branch Meeting 9.30 am 4 Selman’s Parade, Selman’s Hill, Bloxwich, Walsall, WV3 3RN Tel: 0121 378 2888

November 2013 3

Western of Scotland Branch Meeting 10 a.m. Express by Holiday Inn, Springkerse Business Park, Stirling, FK7 7XE Tel: 0141 632 3283

11 West Middlesex Branch Meeting 8 p.m. The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544

24 Essex Branch Meeting 2 p.m. Southend University Hospital Education Centre Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890

December 2013 6

Hants and Dorset Branch Christmas Social Meeting 7.45 p.m. Crosfield Hall, Broadwater Road, Romsey SO51 8GL Tel: 01202 425568

January 2014

11 Surrey and Berkshire Branch A.G.M. 1.30 p.m. Greyfriars Centre, Reading Berkshire Tel: 0208 660 2822 12 Western Branch A.G.M. 12.15 p.m. Blair Bell Education Centre, Liverpool Women’s Hospital, Crown Street, Liverpool Further details: 01745 331827 14 North West Branch A.G.M. 7.00 p.m. St Joseph’s Parish Centre, Harpers Lane, Chorley, Lancs Tel: 0161 486 9234

15 Hants and Dorset Branch A.G.M. 7.45 p.m. Crosfield Hall, Broadwater Road, Romsey SO51 8GL Tel: 01202 425568

16 Birmingham Branch A.G.M. 8 p.m. British red Cross Centre, Evesham, Worcs. Tel: 01905 454116 19 Essex Branch A.G.M. 2 p.m. Southend University Hospital Education Centre Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890

19 Western of Scotland Branch A.G.M. 11 a.m. Express by Holiday Inn, Springkerse Business Park, Stirling, FK7 7XE Tel: 0141 632 3283 page | 37

40025 Chiropody Mar-Apr 2013 12/02/2013 09:13 Page 40

A step forward in managing INGROWING TOENAILS GENTLY CUSHIONS AND PROTECTS

INGROWING TOENAILS CAN BE MANAGED IN THE EARLY STAGES BY OFFSETTING PRESSURE AWAY FROM THE AFFECTED AREA. The design of the Carnation Ingrowing Toenail Protector is based on the measurements and 3D images of the big toes of a representative sample of the UK population. These have been used to mould a specially formulated high performance gel which creates a secondary layer of protection around the toe while leaving the painful area clear from any additional pressure which would exacerbate the condition.

BENEFITS INCLUDE: CUSHIONS AND PROTECTS INSTANT RELIEF WASHABLE AND REUSABLE EXTRA SOFT GEL ONE SIZE FITS ALL

IN A USER TRIAL: 84% said the product gently cushioned and protected the nail 66% of users stated they had instant relief from the product “An innovative and useful product - I wish this had been invented years ago. I’ve noticed a substantial improvement during use as shoes are no longer rubbing”.

PODIATRIST DESIGNED

“The product was fantastic, it prevented my shoes from pressing on the delicate area of my ingrowing toenail and reduced discomfort”. Reference Cliniresearch on behalf of Cuxson Gerrard & Co Ltd amongst 68 patients with ingrowing toenails.

Cuxson Gerrard & Co. Ltd., 125 Broadwell Road, Oldbury, West Midlands B69 4BF