Perceptions of podiatrists and physiotherapists working together

Physiotherapists and podiatrists are working closer together in musculoskeletal services than ever before. The Musculoskeletal Services Framework (2006)1 called for a shared care approach in the management of musculoskeletal conditions. Allied Health Professionals (AHPs) have been challenged to be open to change “in the way they work, in the roles they play and in the care they give” 2 . It has been suggested that changes to healthcare delivery will mean that the current structure of professions may not be sustainable3

Podiatrists interpretation and use of evidence in MSK practice

Background - The development of podiatric biomechanics could be seen as part of a wider quest for legitimacy by the profession, allowing podiatrists to improve their professional status by claiming a body of knowledge and skills and enabling podiatrists to access a different group of patients. However, podiatric biomechanics theories and effectiveness of functional orthoses have been called into question, as there may be little research evidence to support them. There are many podiatrists who would argue with this statement and point to evidence that functional orthoses are an effective treatment for musculoskeletal conditions. These conflicting views of evidence have not affected the growth of the MSK specialism within podiatry. Methods - This study was a qualitative study, which explored podiatrists’ beliefs about evidence-based practice in MSK practice, their perceptions of the interpretation of research and other forms of evidence. 17 in-depth interviews were conducted with podiatrists, 9 NHS, 6 private, 2 academics, who treat MSK conditions with functional orthoses. The data was analysed through a hermeneutic approach that using interpretative phenomenological analysis. This is less focused on phenomenological description, more on interpreting the data in a wider social, cultural and theoretical context. Findings and Discussion - The participants understand the concept of evidence-based practice, as the application of quantitative research evidence to their practice. Research evidence cannot always be easily applied in practice due to the variances in orthotic design, in the causes of MSK conditions and the differences in patients’ lifestyles and preferences. Research evidence does inform their practice but they tend to interpret research evidence according to their own experiences. The participants value their clinical experience, which is formed by testing of orthotic materials and designs and patient responses to them. The evidence that they use could be described as a process of trial and error informed by their patient feedback. A lack of this experience may lead to inexperienced podiatrists’ being unsure about which treatments to give. Patient feedback was seen as the most important form of evidence. However, outcome data was collected only by some of the participants and this was rarely collated and analysed. Conclusions – The participants may not be undertaking evidence based practice as they define it, as using research evidence in practice. They use their clinical experience more than research evidence in practice. They interpret and use research evidence through their own practical experience. Their experience is formed by a process of trial and error, with orthotic designs, and patient feedback about their treatments. The dependency of podiatric MSK practice on patient evidence rather than research has lead to fears that podiatrists’ claims of legitimacy in MSK practice may be questioned. These fears may be allayed by more comprehensive evaluation of the efficacy of functional orthoses through the collation and analysis of outcome data. There also needs to be a wider debate in podiatry about the definition of evidence in evidence based practice and the types of evidence that are really utilised in practice

Medial longitudinal arch development of school children : The College of Podiatry Annual Conference 2015: meeting abstracts

Background Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. The influence of footwear on MLA development is also unknown. Aim This study aims to (i) clarify whether the MLA is still changing in children from age 7 to 9 years old and (ii) explore the relationship between footwear usage and MLA development, using a longitudinal approach. Methods We evaluated the MLA of 111 healthy school children [age = 6.9 (0.3) years] using three parameters [arch index (AI), midfoot peak pressure (PP) and maximum force (MF: % of body weight)] extracted from dynamic foot loading measurements at baseline, 10-month and 22-month follow-up. Information on the type of footwear worn was collected using survey question. Linear mixed modelling was used to test for differences in the MLA over time. Results Insignificant changes in all MLA parameters were observed over time [AI: P = .15; PP: P = .84; MF: P = .91]. When gender was considered, the AI of boys decreased with age [P = .02]. Boys also displayed a flatter MLA than girls at age 6.9 years [AI: mean difference = 0.02 (0.01, 0.04); P = .02]. At baseline, subjects who wore close-toe shoes displayed the lowest MLA overall [AI/PP/MF: P < .05]. Subjects who used slippers when commencing footwear use experienced higher PP than those who wore sandals [mean difference = 31.60 (1.44, 61.75) kPa; post-hoc P = .04]. Discussion and conclusion Our findings suggested that the MLA of children remained stable from 7 to 9 years old, while gender and the type of footwear worn during childhood may influence MLA development. Clinicians may choose to commence therapy when a child presents with painful flexible flat foot at age 7 years, and may discourage younger children from wearing slippers when they commence using footwear

Perceptions of Podiatrists and Physiotherapists Working Together in the Musculoskeletal Service

Physiotherapists and podiatrists are working closer together in musculoskeletal services than ever before. This study aimed to look at the role of each profession within the musculoskeletal team, issues of role overlap and professional boundaries and the effects of working together has had on their practice. Their opinion was also sought on the future of both their role and the musculoskeletal team. The study was a qualitative design using a hermeneutic approach. There were four participants, two from each profession, who work closely with the other profession. Data was collected through semi-structured interviews and a focus group. The findings from the study were wide ranging. All participants enjoyed working together and felt this had improved patient care. They value a team approach based on equal status and appreciation of skills between the professions. Blurred boundaries and areas of role overlap exist between the professions. Government initiatives are treated with mistrust and are seen as attempts to undermine the professions’ current role and status. Consequently there is a resistance to change of role. Conflict with the medical profession and the Allied Health Professions was uncovered. Interprofessional education was initially seen as having little value, but the participants did agree that it could be beneficial for producing effective team workers. Further research is needed in this area as this is a small study and the findings may not be representative of a larger population

Lower back pain: a need for thorough assessment

Making a detailed assessment is vital for an accurate diagnosis of lower back pain and appropriate management

How do MSK podiatrists interpret evidence in practice? - Initial findings

Rationale Podiatry has accepted Evidence Based Practice as a model of clinical practice. The focus of the profession has been to improve the research evidence for podiatric treatments to enhance the security and development of their role in healthcare provision (Vernon 2003). There has been a large amount of research into the effectiveness of functional orthoses as a treatment for MSK conditions, yet this does not give a podiatrist clear answers. A Cochrane review into the effectiveness of functional orthoses suggests that orthoses are effective in the treatment of certain MSK conditions, for example, plantar fasciitis and reducing pain associated with the first metatarsal-phalangeal joint (Hawke 2008). Other Cochrane reviews of MSK conditions; patellofemoral pain (Hossain et al 2011), prevention of running injuries (Yeung et al 2011) and Morton’s neuroma (Thomson et al 2004) show that orthoses have limited effects on these conditions. Research into the affect of evidence on practice appears to fall into two broad categories, research utilisation and knowledge transfer/translation. Research utilisation only looks at the use of research evidence in practice, this clearly is not the only evidence that is used in practice. Knowledge transfer/translation has been defined as a potential solution to the gap between knowledge and practice in order to realise the benefits of research in improved health outcomes measures (Scott et al 2011). Evidence for clinical practice is complex and is made up of research evidence, clinical experience, local information and circumstances and patient experience and preferences (Rycroft-Malone et al 2004) and which of these podiatrists use in practice will be explored in this study. Method This is a qualitative study using a hermeneutic approach to gain an understanding of the meaning of evidence to MSK podiatrist in practice. The data will be collected in semi-structured interviews with 20 MSK podiatrists. Data analysis will be undertaken using a hermeneutical approach. The initial step of analysis will be to develop thematic categories to code the transcripts; this form of editing analysis style is widely used in phenomenological and hermeneutic studies (Polit & Beck 2004). Analysis will begin with listening to the audio files, then analysis of each individual transcript by reading then re-reading and re-listening. During this process the researcher will refer back to the reflexive journal to revisit his thoughts and impressions from the original interviews. Each transcript will then be coded with the thematic categories. Significant statements will be extracted from the transcript and matched to the themes. This will then be interpreted into a restatement of meaning. The meanings for each transcript will be then integrated together to give overall theme clusters, which will form the basis for the discussion (Holloway & Wheeler 2002, Polit & Beck 2004). Findings and Discussion Initial findings from the analysed interviews will be presented. References Hawke F, Burns J, Radford JA, du Toit V. (2008) Custom-made foot orthoses for the treatment of foot pain. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006801. DOI: 10.1002/14651858.CD006801.pub2. Holloway I., Wheeler S. (2002), Qualitative Research in Nursing, 2nd edition, Oxford UK, Blackwell Science Limited Hossain M, Alexander P, Burls A, Jobanputra P. (2011) Foot orthoses for patellofemoral pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD008402. DOI: 10.1002/14651858.CD008402.pub2. Polit D.F., Beck C.T. (2004), Nursing Research: Principles and Methods, 7th edition, Philadelphia PA, Lippincott Williams & Wilkins. Rycroft-Malone J., Seers K., Titchen A., Harvey G., Kitson A. & McCormack B. (2004) What counts as evidence in evidence-based practice? Journal of Advanced Nursing 47(1), 81–90 Scott et al (2011) A protocol for a systematic review of knowledge translation strategies in the allied health professions. Implementation Science 6:58. Thomson CE, Gibson JNA, Martin D.(2011) Interventions for the treatment of Morton’s neuroma. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003118. DOI: 10.1002/14651858.CD003118.pub2. Vernon W. (2003) Evidence-based practice, British Journal of Podiatry, 6(2), 35 Yeung SS, Yeung EW, Gillespie LD. (2011) Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001256. DOI: 10.1002/14651858.CD00125

What can an Evidence Based Practice model tell us about Podiatric Biomechanics?

Rationale There has been an almost constant debate within podiatry about the evidence for podiatric biomechanics. Podiatric biomechanics theories and effectiveness of functional orthoses have been called into question, as there may be little research evidence to support them (Chevalier & Chocklingham 2012). There are many podiatrists who would argue with this statement and point to evidence that functional orthoses are an effective treatment for musculoskeletal conditions (Collins et al 2006). Method This presentation will evaluate the current evidence in podiatric biomechanics through a concept analysis using a conceptual model of an Evidence Based Practice (EBP) approach to clinical practice . Di Censa et al (2005) explain the framework of EBP as the integration into clinical decision making of research evidence, patient preferences, clinical state and circumstances and healthcare resources. Clinical expertise has the central role of balancing these components to achieve the best clinical outcome for the patient. Analysis This analysis will look at the evidence by utilising four of the domains of EBP. Research evidence will appraise the evidence for treatment with functional orthoses. Clinical state will assess the evidence for current biomechanics theories. Patient preferences will review the evidence for patient satisfaction with functional orthoses. Healthcare resources will attempt to look at the cost effectiveness of functional orthoses as a treatment. Discussion This review will critically discuss the areas of strength in podiatric biomechanics for the profession to build on. It will also highlight the gaps in evidence for research to focus on and add to the current debate within podiatric biomechanics. References Chevalier T. Chockingham N. (2012) Effects of foot orthoses: How important is the practitioner? Gait & Posture, 35 (2012) 383–388 Collins N.et al (2006) Lower limb overuse injuries and foot orthoses: A systematic review, Journal of Science and Medicine in Sport Volume 9, Supplement, Pages 32–33 DiCensa A. Guyatt G. Ciliska D. (2005) Evidence Based Nursing: A Guide to Clinical Practice. Mosb

First metatarsophalangeal joint arthrodesis/fusion:a systematic review of modern fixation techniques

BACKGROUND: First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the literature. Various fixation techniques offer differences in union rates, complications and functional outcomes, stirring debates about which produces the best outcomes for patients. Therefore, this review aims to synthesise and compare the outcomes of modern fixation techniques used for first metatarsophalangeal joint (FMPJ) arthrodesis. METHODS: The electronic database searched were PubMed, CINAHL, Cochrane Library, and Google Scholar. The critical appraisal skills programme tool for cohort study was used. The interventions consisted of screw(s), plate(s), and staple(s). Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded. Participants were adults over 18 years, undergoing FMPJ arthrodesis in the UK. Studies with the population consisting primarily of revision cases, patients with rheumatoid arthritis or diabetes were excluded. RESULTS: Seven UK studies included 277 feet and a 95.7% overall union rate at a mean union time of 83.5 days. Staples had the highest union rate of 98.2% at mean union time of 84 days, followed by plates (95.2%, 92 days), and finally screws (94.9%, 71 days). The overall complication incidence is 5.8%. All of the fixation techniques produced good functional outcomes postoperatively. CONCLUSIONS: Whilst staple techniques showed the highest union rate, plating techniques are preferable over screws or staples for better results across several outcome measures, including reduced complication incidence, stability, early ambulation, and good functional outcome. The Manchester-Oxford Foot Questionnaire and EuroQol-5Dimensional are recommended as measurement tools to assess functional outcomes following FMPJ arthrodesis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13047-022-00540-9