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23rd Australasian Podiatry Conference
GOLD COAST 09
Striving for Gold-Standard
Clinical Practice
Gold Coast Convention Centre: Gold Coast, Queensland
Tue 12th May – Sat 16th May 2009
Deadline for abstracts: Friday, 3rd October 2008
Gold Standard Abstracts
Quantitative
Qualitative
OtherThe Prevalence And Impact Of Multiple Joint Problems
Anne-Maree Keenan BAppSc(Pod), MAppSc.; Professor Alan Tennant BHons, PhD; Professor Paul Emery BA, MA, MB, MD, MRCP, FRCP; Dr Philip Conaghan MBBS, FRACP
Academic Unit of Musculoskeletal Disease and Rehabilitation, University of Leeds, 36 Clarendon Rd, Leeds, LS2 9NZ, West Yorkshire, England.
Phone: +44 113 392 4947
Email: a.keenan@leeds.ac.ukBackground
Joint pain is common, with two out of three people over the age of 50 reporting recent musculoskeletal pain1. While there is a tendency for assessment and treatment guidelines to focus on single joint pathology2, this may ignore the true impact of multiple joint problems.
Objectives
The aim of this study was to (a) to determine the prevalence of single and multiple joint problems in the community over the age of 55 years and (b) to evaluate the impact of both single and multiple joint problems on functional ability.
Methods
A community based postal questionnaire was designed to capture information on joint problems. Self assessment of overall body pain, swelling and stiffness and functional activities of daily living were received from 16,222 people over the age of 55 years (86% response rate). Prevalence estimates of joint problems were established and the associated difficulties in undertaking common physical tasks were undertaken using logistic regression modelling.
Results
The incidence of joint problems was high (379.64 per 1,000). Single joint involvement was unusual: the most commonly reported number of joint problems was 4 (range: 0 to 21). While the knee was the most frequent joint involved (220.30 per 1,000), in only 8% of cases was it the only joint involved. The most common combination of joint problems with the knee was with feet, hands and/or hips. The prevalence of foot and ankle problems was substantial: 184.33 per 1,000, second only to knee problems. When adjusted for age, gender and presence of co-morbidities, joint pathologies increased the risk of experiencing difficulty with functional tasks: those with knee pain were three times more likely to report difficulty walking, rising from a seated position and walking up and down stairs (OR=3.02, 3.30, 3.47; p=0.000 respectively). However, this risk was substantially increased when considered in conjunction with common multiple site problems: those with knee and feet problems were 14 and a half times more likely to experience difficulty standing and walking (OR=14.50), while those with knee and hip problems increased their risk over 12 times (OR=12.43); those with knee, back, feet and hip involvement increased their risk by 40 (OR=39.44). Upper limb problems also had an impact on functional ability: while shoulder problems only increased the risk of difficulty in walking minimally, when combined with knee problems, the risk was more than double that of knee alone (OR=7.21).
Conclusion
Joint problems lasting for greater than six weeks were common in the older age group. While a single joint problem had a considerable impact on a person’s functional ability, multiple joint problems were more frequently reported. Furthermore, this exponentially increased people’s ability to undertake functional tasks. The results suggest the assessment and management guidelines for joint problems, particularly knee pathology, need to be re-evaluated and include consideration of the concomitant joint problems.
References
1. Thomas E, Wilkie R, Peat G, Hill S, Dziedzic K, Croft P. The North Staffordshire Osteoarthritis Project- NorStOP: prospective, 3-year study of the epidemiology and management of clinical osteoarthritis in a general population of older adults. BMC Musculoskeletal Disorders. 2004;5(1)
2. Pendleton A, Arden N, Dougados M, et al. EULAR recommendations for the management of knee osteoarthritis. Annals of Rheumatic Disease 2000;59:936-244.
Custom Foot Orthoses For Painful Pes Cavus: Randomised ‘Sham’ Controlled Trial
Joshua Burns, B App Sc (Pod) Hons; Jack Crosbie, PhD; Robert Ouvrier, MD; Adrienne Hunt, PhD
PO Box 799, Neutral Bay, NSW, 2089, Australia.
Phone: +61 2 8230 1131
Email: jbur2522@mail.usyd.edu.auBackground
Pes cavus is a multiplanar foot deformity characterised by an excessively high medial longitudinal arch. It commonly features a varus position of the calcaneus, plantarflexed first metatarsal, adducted forefoot and clawing of the digits. Foot pain affects 60% of individuals in this group, which is thought to result from abnormal plantar pressure distribution1. Preliminary field work suggest that custom foot orthoses may be a worthwhile conservative treatment option for patients with painful pes cavus, by way of reducing and redistributing plantar pressure2. We sought to further investigate the clinical efficacy of custom foot orthoses by means of a large randomised controlled trial.
Objective
To assess the effectiveness of custom moulded foot orthoses on foot pain and plantar pressure in patients with a cavus foot type.
Design
Randomised, single blinded, ‘sham’ controlled trial.
Setting
Human movement laboratory at a University physiotherapy department.
Participants
Between December 2003 and January 2005, 474 potential subjects were screened for inclusion in this study. Of those, 154 men and women with bilateral pes cavus and chronic foot pain were recruited. The sample was constructed to encompass a wide range of pes cavus aetiologies (134 idiopathic, 15 Charcot-Marie-Tooth disease, 4 Poliomyelitis and 1 Polyneuropathy) and foot pathologies (metatarsalgia, sesamoiditis, plantar heel pain etc).
Interventions
Patients were randomly allocated into two groups, one receiving custom moulded foot orthoses and the other ‘sham’ non-moulded insoles. The custom foot orthoses were manufactured to a standardised CADCAM protocol, while the ‘sham’ insoles were fabricated from a flat material with minimal shock absorption. Neutral suspension plaster casts were taken of both feet for all subjects, but were used only to fabricate the custom-moulded foot orthoses.
Main outcome measures
Primary outcome measures were foot pain and disability scores on the Foot Health Status Questionnaire (FHSQ) at 12 weeks. The FHSQ is regarded as an accurate, valid and acceptable means of measuring foot health-related, quality-of-life before and after treatment3. Explanatory analyses were performed on the change in regional pressure-time integrals measured using the pedar-mobile® system (Novel, gmbh, Munich, Germany).
Statistical analysis
All data analyses were carried out according to a pre-established plan. Analysis of data were by intention-to-treat and missing data were replaced by the last value brought forward. Treatment effect, determined by the comparison of change in pain and disability scores between groups were statistically analysed in SPSS for Windows, Version 12.0 (SPSS Inc, Chicago, Illinois). Precision of treatment effect was based on the 95% confidence interval (CI) and P < 0.05.
Results
The custom foot orthoses group comprised 75 patients aged 20-82 years (mean age 49.8 (SD 14.3) years) and the ‘sham’ insole group comprised 79 patients aged 20-85 years (mean age 49.5 (SD 14.4) years). Physical characteristics, foot pain and disability scores were similar between groups at baseline (P>0.05). To date, 100 patients have completed the trial. The remaining 54 will finish the trial mid-April 2005. Full results will be reported and discussed at the 21st Australasian Podiatry Conference.
Acknowledgments
We sincerely thank the Australian Podiatry Education and Research Foundation (APERF), the New South Wales Podiatrists Registration Board and the Prescription Foot Orthotic Laboratory Association (PFOLA) for their financial support of this study.
We would also like to thank ‘A Step Ahead Podiatry’ (St Marys, Australia) for their generous donation of 120 rolls of plaster and facilities for external randomisation and concealed allocation. We also thank Texas Peak Pty Ltd (Tullamarine, Australia) for the low-cost provision of 154 pairs of Brooks socks.
References
1. Burns J, Crosbie J, Ouvrier R, Hunt A. The effect of pes cavus on foot pain and plantar pressure. In: Woodburn J, editor. Emed scientific meeting; 2004 July 29 - August 1; Leeds, U.K.; 2004. p. 18.
2. Burns J. The assessment and management of a patient with painful idiopathic pes cavus. Australasian Journal of Podiatric Medicine 2004;38(2):49-53.
3. Landorf KB, Keenan AM. An evaluation of two foot-specific, health-related quality-of-life measuring instruments. Foot Ankle Int 2002;23(6):538-46.
Attitudes Of Podiatrists Towards Prescription Of Foot Orthoses By Other Health Professions
Katrina Richards B.Pod (Hons), B.A.(Public Relations); Adam Bird, B.Pod (Hons)
24 Brazier Street, Eaglehawk, VIC, 3556, Australia
Phone: +61 3 5446 9098
Email: katrinaellen@yahoo.com.auIntroduction
The use of foot orthoses is a cornerstone of podiatric practice and podiatrists are arguably the principle providers of foot orthoses in Australasia. However, the extent to which other health professions use foot orthoses as part of their scope of practice is unknown. There is little published research related to this area, which perhaps relates to the sensitivity of the topic.
Method
To investigate this issue, a questionnaire was developed and 400 copies were sent to all private and public sector members of the Australian Podiatry Association (Victoria), (student members, first year practitioners and non-practising members were excluded). The questionnaire aimed to determine podiatrists’ own prescribing habits, what they believed they knew of the foot orthoses prescribing habits of health professionals in their local area, as well as questions relating to marketing and restriction of professional practice. Ethical approval was obtained from La Trobe University.
Results
A 43% response rate was achieved; demographics of respondents were similar to the 1999 Labor Force survey (AIHW, 2002); and, respondents worked predominantly in the private sector (77%). Whilst the ‘average’ podiatrist was not found to prescribe large numbers of foot orthoses on a monthly basis, foot orthoses were found to be a major source of revenue for private podiatry practices, with 51% of private practitioners estimating that foot orthoses made up between 20-39% of their total practice revenue Respondents indicated that, generally, orthotists were the only profession believed to prescribe custom made foot orthoses, whilst pre-fabricated devices were predominantly believed to be issued by physiotherapists or pharmacies/retail. From the data collected, chiropractors, osteopaths and myotherapists were believed to be more likely to refer to podiatrists than to prescribe foot orthoses themselves. Overall, opinions of the foot orthoses prescribed by professions other than podiatry were generally negative. Examples of common themes identified were that other professions ‘under-corrected’ or ‘prescribed the wrong device for the abnormality detected’. Orthotists, physiotherapists, biomechanists and retail outlets were identified as frequent advertisers of foot orthoses services. Nearly one quarter of respondents said they did not clearly identify themselves as podiatrists in their advertisements and only 34% chose to advertise biomechanics or foot orthoses in their marketing. Three-quarters of respondents believed that there should be restrictions placed on which professions can be allowed to prescribe foot orthoses, particularly custom-made foot orthoses.
Conclusion
This research suggests that podiatrists are still the principal providers of custom made foot orthoses in Victoria, with a strong referral base from many other health professions. It would appear that there are more non-podiatry health professions referring foot orthoses patients to podiatrists than prescribing themselves. Based upon the results of this study, the authors believe that podiatrists should always identify their profession within advertising, and to make particular mention of foot orthoses if such a service is offered within a practice. On a state and national level, it would appear an ideal time to allocate additional resources to reinforce the message that podiatrists are leaders in the provision of foot orthoses to both other professions and the general public. This study involved perceptions of podiatrists regarding conduct of other health professionals, which are likely to be biased and inaccurate in some respects. Therefore, to obtain a better picture of the foot orthoses marketplace in Australia, further research into the prescribing habits of other health professions is required to enable the podiatry profession to plan for the future.
Acknowledgement
This study received sponsorship from Otto Bock HealthCare.
References
1. Australian Institute of Health and Welfare (2002) Podiatry labour force 1999. Australian Institute of Health and Welfare, Canberra.
Rural And Remote Podiatry: A Journey Into The Great Sandy Desert
Meg Risk, NZ Dip. Pod.
PO Box 1228, Karratha, WA, 6714, Australia.
Phone: +61 8 9185 1666
Email: mrisk@pdgp.com.auWorking as a Podiatrist in remote and rural Australia is a challenging and immensely rewarding experience. This presentation is an insight into the More Allied Health Services funded delivery of Podiatry services into three remote Indigenous communities in northwest Western Australia.
First hand observations were made, highlighting factors that need to be considered and overcome to provide a worthwhile sustainable Podiatry service. Through a journal and photos of recent visits, this presentation will give delegates a glimpse of what working in Indigenous communities is like. Areas of discussion will range from the plane trip in to the desert sunsets, highlighting the challenges and opportunities in between.
Challenges to be overcome include:
- Lack of clients due to cultural meetings, funerals and hunting expeditions.
- Environmental factors like coping with over forty degree heat and cyclones.
- Logistical factors such as available clinic space, weight restrictions and space on the plane and accommodation at the communities.
- Clinical issues to be considered are infection control, physical working environment and lack of continuity of care.
- Cultural considerations include lack of trust of the service provider, language difficulties and use of culturally appropriate etiquette.
With the challenges addressed, the Great Sandy Desert trip concluded having travelled 2360 km's in two days and provided twenty seven episodes of Podiatry service. Existing professional relationships were strengthened and Podiatry services were delivered to some of the most remote communities in Australia.
Recommendations for improving the service provision will be discussed, these include up skilling Podiatrists on indigenous culture, facilitating more remote and rural placements at an under graduate level, more lateral thinking with regard to treatment regimes and effective use of funds to provide a regular continuous service.
