Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

<p>Abstract</p> <p>Background</p> <p>Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy.</p> <p>Methods/design</p> <p>A randomised single-blinded clinical trial will be conducted to investigate the clinical efficacy and cost effectiveness of foot orthoses in the management of patellofemoral pain syndrome. One hundred and seventy-six participants aged 18–40 with anterior or retropatellar knee pain of non-traumatic origin and at least six weeks duration will be recruited from the greater Brisbane area in Queensland, Australia through print, radio and television advertising. Suitable participants will be randomly allocated to receive either foot orthoses, flat insoles, physiotherapy or a combined intervention of foot orthoses and physiotherapy, and will attend six visits with a physiotherapist over a 6 week period. Outcome will be measured at 6, 12 and 52 weeks using primary outcome measures of usual and worst pain visual analogue scale, patient perceived treatment effect, perceived global effect, the Functional Index Questionnaire, and the Anterior Knee Pain Scale. Secondary outcome measures will include the Lower Extremity Functional Scale, McGill Pain Questionnaire, 36-Item Short-Form Health Survey, Hospital Anxiety and Depression Scale, Patient-Specific Functional Scale, Physical Activity Level in the Previous Week, pressure pain threshold and physical measures of step and squat tests. Cost-effectiveness analysis will be based on treatment effectiveness against resource usage recorded in treatment logs and self-reported diaries.</p> <p>Discussion</p> <p>The randomised clinical trial will utilise high-quality methodologies in accordance with CONSORT guidelines, in order to contribute to the limited knowledge base regarding the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome, and provide practitioners with high-quality evidence upon which to base clinical decisions.</p> <p>Trial registration</p> <p>Australian Clinical Trials Registry ACTRN012605000463673</p> <p>ClinicalTrials.gov NCT00118521</p

Diabetes foot disease: the Cinderella of Australian diabetes management?

Diabetes is one of the greatest public health challenges to face Australia. It is already Australia’s leading cause of kidney failure, blindness (in those under 60 years) and lower limb amputation, and causes significant cardiovascular disease. Australia’s diabetes amputation rate is one of the worst in the developed world, and appears to have significantly increased in the last decade, whereas some other diabetes complication rates appear to have decreased. This paper aims to compare the national burden of disease for the four major diabetes-related complications and the availability of government funding to combat these complications, in order to determine where diabetes foot disease ranks in Australia. Our review of relevant national literature indicates foot disease ranks second overall in burden of disease and last in evidenced-based government funding to combat these diabetes complications. This suggests public funding to address foot disease in Australia is disproportionately low when compared to funding dedicated to other diabetes complications. There is ample evidence that appropriate government funding of evidence-based care improves all diabetes complication outcomes and reduces overall costs. Numerous diverse Australian peak bodies have now recommended similar diabetes foot evidence-based strategies that have reduced diabetes amputation rates and associated costs in other developed nations. It would seem intuitive that “it’s time” to fund these evidence-based strategies for diabetes foot disease in Australia as well

Non-medical prescribing in Australasia and the UK: the case of podiatry

Background: the last decade has witnessed a rapid transformation in the role boundaries of the allied healthprofessions, enabled through the creation of new roles and the expansion of existing, traditional roles. A strategyof health care ‘modernisation’ has encompassed calls for the redrawing of professional boundaries and identities,linked with demands for greater workforce flexibility. Several tasks and roles previously within the exclusive domainof medicine have been delegated to, or assumed by, allied health professionals, as the workforce is reshaped tomeet the challenges posed by changing demographic, social and political contexts. The prescribing of medicinesby non-medically qualified healthcare professionals, and in particular the podiatry profession, reflects thesechanges.Methods: using a range of key primary documentary sources derived from published material in the publicdomain and unpublished material in private possession, this paper traces the development of contemporary UKand Australasian podiatric prescribing, access, supply and administration of medicines. Documentary sourcesinclude material from legislative, health policy, regulatory and professional bodies (including both State and Federalsources in Australia).Results: tracing a chronological, comparative, socio-historical account of the emergence and development of‘prescribing’ in podiatry in both Australasia and the UK enables an analysis of the impact of health policy reformson the use of, and access to, medicines by podiatrists. The advent of neo-liberal healthcare policies, coupled withdemands for workforce flexibility and role transfer within a climate of demographic, economic and social changehas enabled allied health professionals to undertake an expanding number of tasks involving the sale, supply,administration and prescription of medicines.Conclusion: as a challenge to medical dominance, these changes, although driven by wider healthcare policy,have met with resistance. As anticipated in the theory of medical dominance, inter-professional jurisdictionaldisputes centred on the right to access, administer, supply and prescribe medicines act as obstacles to workforcechange. Nevertheless, the broader policy agenda continues to ensure workforce redesign in which podiatry hasassumed wider roles and responsibilities in prescribing

REVIEW ARTICLE: Toenail onychomycosis: an important global disease burden

Onychomycosis is a fungal infection of the nail plate or nail bed. It does not usually cure itself and it can trigger more infectious lesions in other parts of the body. The reported prevalence of onychomycosis is increasing in Western countries, presumably due to lifestyle changes and the ageing of the population. Approximately 10% of the general population, 20% of the population aged &gt;60 years, up to 50% of people aged &gt;70 years and up to one-third of diabetic individuals have onychomycosis. Care should be taken for the accurate diagnosis and timely treatment of toenail onychomycosis to prevent complications. Current treatment options have relatively limited therapeutic success, particularly long-term. Oral medications are associated with high recurrence rates and treatment failure, and are not suitable for many cases due to potential adverse effects. Topical medications are recommended only for mild to moderate cases. The cost of therapies may also be prohibitive in some cases. In the light of these issues, more research is warranted for the investigation and development of more effective and economical options for the treatment and prophylaxis of toenail onychomycosis. In patient populations such as diabetic individuals, where onychomycosis can provoke lower extremity complications, professional podiatry care of toenails and feet should be encouraged.</p