Process evaluation of podiatric treatment of patients with forefoot pain (original) (raw)
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Journal of Foot and Ankle Research, 2011
Foot problems in general and forefoot problems in particular can lead to a decrease in mobility and a higher risk of falling. Forefoot problems increase with age and are more common in women than in men. Around 20% of people over 65 suffer from non-traumatic foot problems and 60% of these problems are localised in the forefoot. Little is known about the best way to treat forefoot problems in older people. The aim of this study is to compare the effects of two common modes of treatment in the Netherlands: shoe advice and podiatric treatment. This paper describes the design of this study. The study is designed as a pragmatic randomised clinical trial (RCT) with 2 parallel intervention groups. People aged 50 years and over who have visited their general practitioner (GP) with non traumatic pain in the forefoot in the preceding year and those who will visit their GP during the recruitment period with a similar complaint will be recruited for this study. Participants must be able to walk unaided for 7 metres and be able to fill in questionnaires. Exclusion criteria are: rheumatoid arthritis, neuropathy of the foot or pain caused by skin problems (e.g. warts, eczema). Inclusion and exclusion criteria will be assessed by a screening questionnaire and baseline assessment. Those consenting to participation will be randomly assigned to either a group receiving a standardised shoe advice leaflet (n = 100) or a group receiving podiatric treatment (n = 100). Primary outcomes will be the severity of forefoot pain (0-10 on a numerical rating scale) and foot function (Foot Function 5-pts Index and Manchester Foot Pain and Disability Index). Treatment adherence, social participation and quality of life will be the secondary outcomes. All outcomes will be obtained through self-administered questionnaires at the start of the study and after 3, 6, 9 and 12 months. Data will be analysed according to the "intention-to-treat" principle using multilevel level analysis. Strength of this study is the comparison between two common primary care treatments for forefoot problems, ensuring a high external validity of this trial. Netherlands Trial Register (NTR): NTR2212.
Clinical audit of core podiatry treatment in the NHS
Journal of Foot and Ankle Research, 2009
Background: Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period.
An investigation into the clinical reasoning of both expert and novice podiatrists
The Foot, 2006
Background: It is important to understand how clinical reasoning occurs in podiatry so that podiatrists may be able to make the correct diagnosis and patients may benefit from the correct treatment. It is also important for the education of podiatry students and experts in specialist area of podiatry, so they may be taught procedures for clinical reasoning and problem based learning. Currently, there is little information as to how this process is achieved in the domain of podiatry. Objectives: The aim of this study was to investigate clinical reasoning in podiatry in both expert and novice podiatrists. Method: Think-aloud protocols were used to investigate the clinical reasoning of expert and novice podiatrists in general and specialist clinics. The think-aloud protocols were later analysed for content and themes were produced to help understand the process of clinical reasoning in podiatry. Results: Some of the themes used in clinical reasoning are common to experts in general podiatry practice and specialist podiatry practice. However, there is an increase in the number of clinical reasoning themes used by experts in a specialist setting than in a general setting.
The purpose of this paper is to evaluate what evidence exists to support core podiatry services by reviewing foot survey data on the amount and type of foot conditions suffered in different populations. Twenty-six articles published between 1967 and 2004 inclusively were appraised. The most common conditions reported were problem nails, corns, callus and toe deformities, though some complex functional foot problems were not screened for in many of the studies. Results from the combined surveys suggest many of the foot problems found would require core podiatry care. This, however, is currently being phased out in some NHS podiatry departments. Further research is required to assess outcomes on foot health after receiving core podiatry to increase the evidence base of this central podiatric role. This should be carried out in conjunction with implementation of more preventative strategies to reduce the development of some common foot problems and development of assistant practitioners in podiatry to provide much of this core work.
Why Podiatry is a Must for the Health Care System in Romania
Romanian Journal of Diabetes Nutrition and Metabolic Diseases, 2020
It can seem strange for the most of the health care professional from the western countries (and Australia) that, in the second decade of the XXI century, some of us are trying to convince regulatory bodies from our country (and from other countries from Eastern Europe) that podiatry, as a job, has an essential and time-honored place in the panel of the health care dedicated jobs. Foot care is a job with documented roots in Ancient Egypt and has a rich history, from “corn cutters” to “chiropody”, “podology” and reaching today to the worldwide recommended name “podiatry” and the degree of Doctor in Podiatric Medicine in the US (the equivalent of MD in the US). Some of the cornerstones of this long history are Paul of Aegina who in the VIIth century has given the first definition of “corn”, continuing with Nicolas Laurent Laforest, the author of the first textbook dedicated to foot care (” Art de Soigner les Pied”, 1781), with special persons as Isachar Zacharie, Abraham Lincoln’s “fo...
Evaluating the outcomes of a podiatry-led assessment service in a public hospital orthopaedic unit
Journal of Foot and Ankle Research, 2014
Background: In Australia, the demand for foot and ankle orthopaedic services in public health settings currently outweighs capacity. Introducing experienced allied health professionals into orthopaedic units to initiate the triage, assessment and management of patients has been proposed to help meet demand. The aim of this study was to evaluate the effect of introducing a podiatry-led assessment service in a public hospital orthopaedic unit. The outcomes of interest were determining: the proportion of patients discharged without requiring an orthopaedic appointment, agreement in diagnosis between the patient referral and the assessing podiatrist, the proportion of foot and ankle conditions presenting to the service, and the proportion of each condition to require an orthopaedic appointment.
Predictors of podiatry utilisation in Australia: the North West Adelaide Health Study
Journal of Foot and Ankle Research, 2008
Background Foot problems are highly prevalent in the community; however no large population-based studies have examined the characteristics of those who do and do not access podiatry services in Australia. The aim of this study was to explore patterns of podiatry utilisation in a population-based sample of people aged 18 years and over living in the northwest region of Adelaide, South Australia. Methods The North West Adelaide Health Study is a representative longitudinal cohort study of 4,060 people randomly selected and recruited by telephone interview. The interview included questions regarding healthcare service utilisation in the past year. Data were also collected on education, income and major medical conditions. Results Overall, 9.5% of the total sample and 17.7% of those who reported foot pain had attended a podiatrist in the past year. Participants who had accessed podiatry treatment were more likely to be female, be aged over 45 years, be obese, and have major chronic medical conditions (osteoporosis, osteoarthritis, diabetes, cardiovascular disease and high blood pressure). Those who reported foot pain but had not accessed a podiatrist were more likely to be male and be aged 20 to 34 years. Conclusion Only a small proportion of people who report foot pain have accessed podiatry services in the past year. There is a need to further promote podiatry services to the general community, particularly to men and younger people.
Journal of Foot and Ankle Research, 2018
Background: A high percentage of the population report footwear related foot pain, yet there is limited research on the effect footwear has on the development of this pain. The aim of this study was to establish whether footwear purchased by patients have an association with foot pain and what choices determined a purchase decision. Methods: Shape and size measurements of the dominant foot and footwear (length and width) were taken from 67 female participants who routinely received podiatric treatment. Participants were also asked to complete a short questionnaire to rate the shoe characteristics, emotions whilst wearing and reasons for the purchase. Results: Results highlighted a high prevalence of structural foot pathology for those over 61 who preferred slip on shoes. This group also wore shoes that were significantly narrower than their feet with width difference correlating to the presence of Hallux Abductovarus (HAV). In addition, results indicate that individual footwear advice is more important than previously thought, as it is clear that choice of footwear worn to podiatry appointments are not always worn on a daily basis. Conclusions: This study emphasises that the width of the shoe is an important part of fit, highlighting the need for patient specific footwear assessment and education for behaviour changes.
University of Salford, 2019
Within the UK public sector, the present healthcare landscape is a result of changing priorities over the last few decades with health care policies requiring healthcare professionals to adapt to new ways of working. These policies reflect the need to sustain a health service which can cope with the shifting demographic of an ageing population and an increase in conditions such as diabetes. These factors have an impact for the profession of podiatry, meaning potential changes influencing the profession, the shape of services delivered and the nature of everyday podiatry practice. This thesis aimed to get a clearer understanding of the influencing factors on practice for podiatrists. It achieved this by using an interpretative phenomenological analysis approach to gain insight into the experiential practice of podiatrists in both specialist and non specialist practice. Specialist podiatry care is needed for foot related complications in diabetes and international guidance IWGDF (2019) has indicated LJM is a contributory risk factor in the development of diabetic foot ulcerations (DFU). However, the characteristics of foot related LJM are not well understood, therefore, at it's outset, this thesis aimed to develop a clearer understanding from experiential practice. This revealed LJM is currently "off the radar" in podiatry practice, partly due to lack of recommendation to assess in UK clinical guidelines and because priority is being given to other assessments. As the thesis shifted focus to professional practice, the superordinate themes, safe in our silos, stretching and sensemaking, steering or sailing, revealed the challenges faced by podiatrists in specialist and non-specialist roles. It is difficult to quantify the impact of health policy and changing organisational needs on professional practice, however the podiatrists in this study were employing a range of strategies to cope with the increasing demands. Some of these demands impact on the internal dynamics within the profession. Therefore, it is vital to encourage leading voices within the profession to help podiatrists with transformational change, and to encourage the next generation of podiatrists to embrace digital health technology, and public health roles in order to grow and develop the profession.