Podiatry Review March/April 2012

ISSN 1756-3291

Podiatry Review Volume 69 No.2. Published by the Institute of Chiropodists and Podiatrists as a Peer Review Journal March / April 2012

Diabetes News Annual Conference and Dinner Dance Information Latest Information Vetting and Barring Scheme

INSTITUTE OF CHIROPODISTS AND PODIATRISTS

M A R C H /A P R I L 2 0 1 2 V O L 6 9 N O . 2

The Institute of Chiropodists and Podiatrists Editor in Chief Roger Henry FInstChP, DChM

PODIATRY REVIEW

Academic Editor Robert Sullivan Dip.Pod.Med., BSc (Hons), PGCert, LA., PGCert.

Contents

Pom's., PGCert N&Skin Surg., PGDip. Pod. Surg., FIChPA., SARSM., MInstChP.

Editorial Assistant Bernadette Willey bernie@iocp.org.uk Editorial Committee Mrs F H Bailey MInstChP Mr W J Liggins FInstChP, FPodA, BSc(Hons) Mrs J A Drane MInstChP Advertising Please contact Julie Aspinwall secretary@iocp.org.uk Published by The Institute of Chiropodists and Podiatrists 27 Wright Street, Southport Merseyside PR9 0TL 01704 546141

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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.

HPC Audits May 2012 ....................................................02 The use of hyfrecation in the treatment of verrucae, a case study ....................................................04 Mr. Robert Sullivan. BSc (Hons), PgDip. Pod. Surg., PgCert.

L.A., PgDip.Pom’s. SARSM, M.Inst.ChP and Ms. Deirdre O’Flynn BSc. (Podiatry) M.Inst.ChP. The opinions and attitudes of HPC registered level 4 podiatry students towards professionalism pre- and postwork placement: a qualitative study ..............................06 Dr Mairghread JH Ellis FHEA BSc MSc DPod, Alex Speers BSc Hons Podiatry, Jenny L Waring BSc Hons Podiatry 2011 Annual General Meeting Nominations for National Office ....................................11 The Problem with Plantar Fasciitis..................................12 Beverley Wright BSc (Hons) PGCE, MInstChP, PGDip Is your First Aid Certificate up to date? ..........................18 The Use of Alcohol Gels for Hand Hygiene for Health Professionals – Electronic Literature Search ..................14 Anne Todd BSc, Pod RMT, MInstChP, MCThA Podiatry as a Profession: My path to becoming a Podiatrist and my experience as a newly Qualified Practitioner Part 3 ..........................................................16 Deirdre O’Flynn BSc, Podiatry, MInstChP Vetting & Barring Scheme and Criminal Records Regime Review recommendations - Latest Update ....................20 Fred Beaumont Obituary ................................................22 Branch News ..................................................................28 Rambling Roads ..............................................................30 Diet rich in flavonoids could provide health benefits for people with Type 2 Diabetes ....................................31 Classified Advertisements ..............................................33 Dates for your Diary........................................................34 National Officers ............................................................36

EXECUTIVE COMMITTEE L-R Julie Dillon, Colette Johnston, Joanne Casey, Martin Harvey, Heather Bailey, Bill Liggins, Jacquie Drane, Robert Sullivan, David Crew, Valerie Dunsworth, Michele Allison, Ann Yorke page | 01

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HPC Audits May 2012 Our profession is due to be audited again in May this year.

Most of our members are aware now of how this works. For new members, CPD audit is the process in which HPC randomly select a percentage of registrants who are renewing their registration and ask them to send in a profile showing how their CPD meets the HPC’s standards. HPC have provided the following information.

What if I'm selected for audit?

Registrants chosen for audit must: send a written profile (which must be their own work and supported by evidence) which explains how the CPD they have done meets standards.

CPD profiles are assessed by CPD assessors from the professions the HPC regulate, who decide if the profile meets the CPD standards.

Putting your CPD profile together The main parts of your CPD profile will be: • a summary of your practice history for the last two years (up to 500 words); • a statement of how you have met our standards of CPD (up to 1500 words); and • evidence to support your statement.

Writing the summary of your practice history Your summary should describe your role and the type of work you do. The summary should include your main responsibilities, identify the specialist areas you work in and identify the people you communicate and work with most.

It may be appropriate to base this part of your CPD profile on your job description. When you have written your statement about how you meet standards for CPD (see the following explanation), you may find it helpful to go back over your summary of work, to make sure that it clearly explains how your CPD activities are relevant to your future or current work.

Writing your statement When you write your statement, HPC expect you to concentrate most on how you meet standards 3 and 4 – how your CPD activities improve the quality of your work and the benefits to service users.

Below, they have suggested how you might want to approach writing your statement.

“We know that not all health professionals have a personal development plan – you may be self-employed, or your employer may not work in this way. But if you do have a personal development plan, you may find it useful to use this as a starting point for writing your statement. If you do not already have a personal development plan, you may find it useful to develop one and to use this approach.

Most personal development plans involve identifying: learning needs; learning activities; 02 | page

types of evidence; and what you have learnt.

You could write a statement on how you have updated your knowledge and skills over the last two years, and what learning needs you have met. You may find it helpful to identify three to six points that have contributed to the quality of your work.

These areas will have been identified through your personal development plan or a review of your role or performance. If you have a personal development plan, you can provide this as part of your evidence.

If you run your own private practice, and you have a business development plan or a similar document, then you may find this a useful starting point for writing your own statement.

If you do not have a personal development plan, or if you would prefer to use another approach to write your statement, you could start with our standards. Using the information we have provided about our standards for CPD, write about how you have met each one. You could split your statement into sections, and dedicate each section to one of our standards.

You do not need to send us the full record of all your CPD activities. In fact, we strongly encourage you not to do so. You may send us a summary of all your activities, but this summary should be only a sheet or two with a very brief list of activities and dates.

If you are chosen for audit, you need to look through your entire record of CPD activities and consider which activities best show how you have met our standards. This should be a mixture of activities that are directly linked to your current or future work, and you should consider how you can provide evidence that these activities have improved your work, and benefited service users.

In all cases, evidence of how you have planned your CPD, what activities you have undertaken, and the effects that this had on how you work and the effects on your service users, will all be helpful to the assessors.

When you put together your profile, you also need to send in evidence to support your personal statement.

In your personal record of CPD activities you may have a large amount of evidence relating to certain activities. However, you do not need to send us all of this information. You need to look at the information you have, decide which activities show how you meet our standards, and then decide what evidence to send to us. You should refer to the assessment criteria in our document, Continuing professional development and your registration.

Make sure you have provided relevant supporting information to show how you meet each of the standards. We do not have detailed guidelines on how much evidence you should send us.

But you should bear in mind that the CPD assessors will need to see enough information to be sure that the CPD activity has taken place.”

For more information, please visit www.hpc-uk.org/registrants/cpd

EDITORIAL

Dear Reader, Please accept that this is the most difficult editorial for me to write as it will be my last one. I have been persuaded to step down and let younger blood take over in this electronic age.

When I think back to when I was appointed Editor in place of my good friend Philip Basham it was a thin A5 journal with no colour. What a difference now!

What makes a good journal? To my mind the key word is balance. If the journal is too full of heavy technical articles it becomes boring. Conversely, if it is too lightweight in content the opportunity to inform and educate is lost.

For whom do we produce Podiatry Review?

Obviously, primarily our members, so we include reports of branch meetings, branch AGMs, personal profiles, practice profiles, reports of our national AGM, new equipment and interesting medications.

What I hate to hear is “I never read it.” What a waste of effort in producing it. What I love to hear is

“I enjoyed reading the Review and I particularly liked the article on page such and such.” Or “I didn’t agree with the article on page whatever”.

At least I knew people had read it.

At this stage I need to thank Mrs Willey (Bernie) for all her input. Indeed without her help the Review, sometimes, would never get to the printers! So thank you Bernie. Thank you too to all the ladies in the office, Jill, Julie and lately Pauline for their good humour and unstinting hard work.

So as I ride off to the West I thank the Institute for the privilege, and I do consider it a privilege, of being the Editor. I did my best.

Roger Henry Editor, Podiatry Review

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The use of hyfrecation in the treatment of verrucae, a case study.

Mr. Robert Sullivan. BSc (Hons), PgDip. Pod. Surg., PgCert. L.A., PgDip.Pom’s.

SARSM, M.Inst.ChP and Ms. Deirdre O’Flynn BSc. (Podiatry) M.Inst.ChP. An old but good definition of hyfrecation is; a form of high frequency electrosurgery where a low powered electrical impulses are delivered to the surface of the skin via a blunt or sharp electrode.(Sebben 1988). The application of the electrode has differing effect on the skin, either elec‐ trodessication, where the tissue is coagulated and desiccated without burning or electrofulguration where the skin is burnt causing carbonisation of the tissue. Current literature shows that hyfrecation itself does not interfere with nerve conduction due to its high frequency (Plant 2002, Gupta 2003, Fernando et al 2004), pain is caused by the heat generated in the tissue. When hyfrecation is used on verrucae the area must be well anesthetised using a suitable local anaesthetic and appropriate infiltration. It is the author’s experience that the lesion is best pared down prior to the use of the hyfrecator. Both techniques of electrodessication and electrofulguration are used to gain adequate access and depth in the removal of the verrucae. Hyfrecation is contraindicated in patients with a pacemaker as there is the potential for interference for the frequency of the pulse generated (Bridenstine 1998).

The Case A 37 year old male presented to clinic with an interesting story in relation to his verraucal presentation. The patient had sought advice from at least three other clinicians and engaged several different treatments including cryotherapy, the application of salicylates and sliver nitrate all to no avail.

By this time the client was frustrated and in an amount of pain in both his foot and his wallet.

The gentleman is employed as a computer technician in the financial services industry and enjoys some light swimming reading and travelling.

The medical history of the patient revealed a heart condition for which he was medicated and also taking a maintenance dose of aspirin 75mg.

A review of his previous treatments shows a number of issues in relation to patient compliance as attendance was sporadic with the patient presenting only when he had pain. This gives reason for the condition continuing for the past five years. At this stage all the patient wants is for the condition to resolve as soon as possible.

The treatments available were discussed with the patient; these included Cantheron Plus®, Spiralarin®, liquid cryogen and surgery. The client decided that he did not have the patience for topical applications and requested hyfrecation under a local anaesthetic.

A full vascular and venous assessment was performed using Doppler® Fig. 1. All pulses were present with no areas of concern Figure 1. Doppler examination Picture from file The implications of surgery were discussed as well as complications which could arise. The patient was told of the importance of compliance to the pre and post op requirements and an information pack given. A letter was sent to the patient’s doctor advising of the condition and the proposed remedy, along with an instruction to withdraw the aspirin five days prior to surgery. The doctor replied and the appointment was made.

Figure 2 shows the patients presentation of recalcitrant verrucae prior to surgery.

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Figure 2 HPV prior to removal. Picture from file.

The patient history was checked and confirmation sought that the aspirin had been withdrawn 5 days post op. Any allergies information was verified and a consent from for the anaesthesia and operation was signed by the clinician and the patient.

The patient was prepared for surgery (a 5ml vial was opened of which 2.5mls was drawn up) and the administration of a post tibial block using a solution of 2% lidocaine was administered. The patient was then left for 20 minutes for the anaesthetics to take full effect.

Figure 3 below shows the anatomy of the nerve and associated structures.

The posterior tibial nerve (arrow, yellow structure) is seen coursing beneath the flexor retinaculum (arrowheads) in this illustration viewed from the medial side. The posterior tibial artery lies next to the nerve. The posteromedial ankle tendons (white arrows) lie along the anterior aspect of the posterior tibial neurovascular bundle.

A good identity maker for the correct location of the nerve is to find the pulse of the PTA and rest a finger on it, aim the needle to just miss the finger for injection of the anaesthetic solution. The anaesthetic should be placed around the nerve not in it.

Figure 3. Showing anatomy for anaesthetic injection.

(Googlemedicalimages) Within this type of surgery two techniques are used to treat the verrucae 1 fulguration and 2 desiccation. Figure 4 below show the two forms of electrosurgery/hyfrecation Figure 4.

(A) Electrodesiccation with an active electrode tip touching the skin and showing penetration of planned tissue damage. (B) Fulguration with sparking from electrode to tissue.

Treatment area is more superficial than in desiccation.

After 20 minutes the patient was taken into the minor procedures room and the procedure commences after the foot had been checked for anaesthesia.

Any excess calus over the verrucae is reduced using a 15 blade or appropriate. The outer border of the verrucae is delineated using the hyfrecator and the surface layer of skin is desiccated using the electrode.

After desiccation the outer layer of skin has a white charred appearance as in Figure 5.

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Figure 5. From file shows hyfrecated delineated verrucae.

This area is now removed using a curette or blade. The process is then repeated until the area is clear of the lesion.

The area is then flashed with the hyfrecator to stop any residual bleeding. The area is then dressed using a dry dressing and pain control advice given.

Figure 6. From file shows a completed excision.

The patient is instructed to keep the wound dry and revisit in 2 days for a dressing change.

Out of hours contact numbers are also given should the patient need them.

Figure 7. from file shows foot being dressed.

The patient revisited in two days and the wound was clean and dry. The patient was given a care pack and a dressing information sheet. Revisits were

arranged at 1 and 3 weeks. The picture below shows the heeled wood 6 weeks post op.

Figure 8. From file.

The authors of this paper have had many years experience of this treatment modality and although it is not always 100% effective used in trained hands it is a safe, fast and well tolerated by the patient. Healing times are quick and pain is minimal. From a Continual Professional Development point of view this is a good tool to add to the podiatry skills pallet for those who use or plan to use local anaesthesia in their practice.

References.

Bridenstine. 1998. Use of ultra-high frequency electrosurgery (radiosurgery) for cosmetic surgical procedures.

Dermatol Surg 24 :397 – 400 Fernando. 2004. Hoyos AD, Litle V, Belani CP, Luketich JD. Radiofrequency ablation: identification of the ideal patient. Clin Lung Cancer; 6:149-153.

Gupta. 2005. Radiofrequency surgery: offering a novel approach to ano‐ rectal diseases. Middle East Journal of Family Medicine. Vol 3(1) Plant. 2002. Radiofrequency treatment for oral HPV. Laryngoscope.; 112: 1256-1259 Sebben. 1988. The status of electrosurgery in dermatologic practice.

J Am Acad Dermatol; 19:542-549 This method of HPV removal will be demonstrated at the Institute’s AGM on Saturday 28th April 2012 by Robert Sullivan.

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The opinions and attitudes of HPC registered level 4 podiatry students towards professionalism pre- and post- work placement: a qualitative study *Dr Mairghread JH Ellis FHEA BSc MSc DPod, Alex Speers BSc Hons Podiatry, Jenny L Waring BSc Hons Podiatry Abstract Introduction: This paper explores professionalism from the perspective of HPC registered 4th year podiatry students at a Scottish university. The Health Professions Council requires registrants to display professional behaviours, and has recently identified professionalism as an area requiring further development and understanding. No current literature was found in this area which relates to newly registered podiatrists.

Aims: This study aimed to gain insight into the opinions and attitudes of newly HPC registered podiatrists towards professionalism before and after a 3 week full time working NHS placement.

Method: Qualitative data was generated using topic led asynchronous online discussions. The researchers acknowledged a degree of reflexivity throughout the study by clearly illustrating their own position within the research process.

Seven level 4 HPC registered podiatry students took part in this study. Data was analysed collaboratively by the research team for emergence of themes, and was set in the context of other relevant research literature.

Findings: Participants gave rich descriptions of personal opinions and relevant examples of professional practices. Three main themes emerged from the discussions: Professional Identity, Professional Standards and Core Values.

Discussion: Professional Identity emerged as the most discussed theme. The discussion pre-placement centred around looking inwardly to aspects of the participants’ own professionalism; whilst post-placement discussions evolved into reflections on experiences and how the participants were able to use their professional skills.

Professional Identity within podiatric practice remains at the forefront of practice – in this research, most specifically in the areas of title and role.

Conclusion: This research offers insight into this small but unique group of podiatrists, who have shown they understand concepts associated with professionalism, and have demonstrated willingness to act professionally. The findings offer a unique contribution to the podiatry‐specific literature on professionalism, and as such, provide evidence from novice practitioners to help inform the professions’ reflections and discourse on professionalism.

Introduction This paper reports the findings of a small study undertaken to explore the opinions and attitudes of 4th year registered Health 06 | page

Professions Council (HPC) podiatrists towards professionalism before and after a 3 week NHS working placement.

Podiatry students at Queen Margaret University (QMU) are in the unique position of being eligible for registration after 3 years of their 4 year degree programme, and HPC registration is a prerequisite for the honours year of study.

Within level 3, the Professional Issues module aims to prepare students for registration, and includes and encourages discursive and reflective elements on the concept of ‘professionalism’.

As level 4 students, and newly registered practitioners, the assumption might be that these students have a fresh understanding of the standards of proficiency required, and are able to demonstrate they can maintain the standard of conduct and professionalism expected of them (HPC, 2011).

Thus the level 4 students are able to undertake clinical placements throughout the fourth year as HPC registered podiatrists and to reflect on their new role as ‘professionals’.

Cruess et al ( 2006) and Freeman and Rogers (2010) describe how educators in the field of allied health recognise the importance of developing professional behaviours in students; very recent research by the HPC has explored professionalism from the perspective of students and educators in three HPC regulated professions (HPC, 2011).

The HPC, in reviewing ‘fitness to practice’ issues, has reported that conduct or professional behaviour is more frequently a problem than competence (HPC, 2009:27). With this in mind, the HPC has stated that the focus of their efforts “should be on professionalism and its constituents rather than on competence which is already being monitored through other means‟ (HPC, 2009:35).

Despite the increasing interest in professionalism there is no full agreement on how to define it (Arnold, 2005). McLachlan et al (2009) have stated that professionalism is subjective and is neither easily defined, nor quantified. Similarly Finne et al (2010) have stated that definitions of professionalism are extensive and disparate, with most authors listing numerous and diverse attributes. Van de Camp et al (2004) have confirmed the great difficulty of defining professionalism further, as they reported that 90 differing attributes of professionalism were identified following a systematic literature review. Most recently, research undertaken by Morrow et al on behalf of the HPC (HPC, 2011: 3) has noted that “the concept of ‘professionalism’ is not well defined, conceptually or methodologically”.

It is obvious from reviewing the literature that much of the

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available and current literature sits within the nursing and medical fields; however, Mandy (2008) and Ellis (2009) represent recent work specific to podiatry, with the HPC’s recent report the most current (HPC, 2011).

to the practicalities and timings of placements within the academic year, 13 potential participants were invited to participate. Seven participants consented and took part, 2 male and 5 female.

Within the HPC document ‘Standards of Proficiency for chiropodists and podiatrists’, under the section of Professional relationships, 1b.1 states that “podiatrists must understand the need to build and sustain ‘professional’ relationships as both an independent practitioner and collaboratively as a member of a team.”

Within the same document under the section Knowledge, understanding and skills, 3a.2 states “that podiatrists must know how ‘professional’ principles are expressed and translated into action through a number of different approaches to practice, and how to select or modify approaches to meet the needs of an individual, groups or communities.” (SoPS for Chiropodists and Podiatrists (HPC, 2005)). Within the Standards of Conduct, Performance and Ethics document, the first point states that “You are responsible for your ‘professional’ conduct, any care or advice you provide, and any failure to act”, and states that “You must keep high standards of personal conduct, as well as ‘professional’ conduct.” (HPC, 2005).

Data Generation

There appears to be no evidence of consensus within literature that agrees upon one sole definition of “professional‟.

The Royal College of Physicians has stated “medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors” (RCP, 2005:14), and discusses the behaviours that strengthen trust as recognisable to everybody – including courtesy, kindness, understanding, humility, honesty and confidentiality (RCP, 2005).

One might consider how HPC registrants may demonstrate “professional‟ relationships, “professional‟ principles, or “professional‟ conduct, if the meaning of the word has not been appropriately defined within the healthcare context, or in this case within the profession of podiatry.

Thus this research aims to explore the opinions and attitudes of newly registered podiatrists towards professionalism.

Methodological approach Due to the exploratory nature of the research question a qualitative study was designed. Saks and Allsop (2007) have noted the importance and legitimacy of such approaches to inform health care policy and practice, and Strauss and Corbin (1990) have stated that qualitative methods are appropriate to uncover and understand what lies behind any phenomenon that is poorly understood. Since the topic of this study is a concept that is ill defined, a qualitative method was considered as most suitable.

Ethical Approval and Recruitment Ethical approval for the study was sought and granted by the relevant divisional ethics committee at Queen Margaret University (QMU).

Sample With the exception of those students undertaking the research, it was envisaged all level 4 QMU student podiatrists could be invited to take part in the study (n=24). However, due

The research team utilised topic - led asynchronous online discussions, via the eLearning platform, WebCT. Not only did this method fit with the time constraints of the research project, but it also presented numerous other advantages, such as the participants’ familiarity with the online discussion process through previous module experience, and freedom to post discussion material at a time which was suitable to them. Rhodes et al (2003) found that online discussions provided participants with a convenient and comfortable way of joining group discussions, unconstrained by place and time. In addition, due to the discussions being of an online asynchronous nature it meant that the postings were made and recorded in real time, as written evidence, so it saved the researchers’ time and expense of transcribing, as well as eliminating transcribers’ bias.

The proposed study took place during the academic year 20102011. There were two discussion areas, one for pre-placement discussion, which ran from November 2010 until January 2011 and another for post-placement discussion, which ran from January 2011 until March 2011.

It was decided that broad areas for exploration would be used in this research, as it has been found that open ended questions and topics encouraged and generated reflective descriptions in the participants own words (Cohen 1987). The research team wanted to promote participants’ discussion and consideration of “professionalism‟, and did not want to influence participants.

However, choosing how to phrase the topic proved to be a difficult aspect of the research, and required much debate and discussion to arrive at a consensus. . The topics that were agreed upon are as follows – 1. Pre placement topic We would like to know what your opinions are, with regard to professionalism. Please expand, in your own words, using examples relevant to your podiatric experiences.

2. Post-placement topic We are interested to know if, since your 3 week working placement, you have experienced any situations or any attitudes that have reinforced or challenged your previous attitudes/ opinions of professionalism.

As level 4 students and HPC registered podiatrists, the researchers were positioned as native within the research, and it was accepted that although appropriate steps were taken not to influence the data, the data were to a degree a co‐construction.

Data Analysis Once all the data was collected, thematic analysis with group triangulation of all the participants’ postings was carried out by the research team. Individual responses for each question were looked at and those responses that identified a similar element of professionalism were grouped together. From this, themes and page | 07

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Professional Standards

Professional identity

Core values

Patient care

Role / scope of practice

Individual attitudes

Codes of conducts

Title

Individual behaviour

Technical skills

Specialism

Communication skills

Appearance

Age

Relationships

Figure 1 – themes and subthemes emerging from the data sub themes were derived from the subjective data by the research team.

Findings There were 6 pre-placement discussions, from 4 female and 2 male (reflective of the year’s ratio of male to female students).

There were 6 post-placement discussions although one of the original male participants did not make any post-placement posting, and one further female participant joined at this point.

It is common with qualitative research for findings to develop from subthemes which are then associated with main themes – a bottom up approach (Greenhalgh, 2010).

Data was compared for similarities with linking arrows which developed into groups of ideas. These groups became sub themes from them the main themes were identified as: Professional standards, Professional identity and Core values.

Initial posts saw an equal amount of all three themes being discussed. However as more participants posted, there was less consistency (for instance the two male participants did not discuss any aspects of identity). Everyone mentioned professional standards and core values enabling practitioners to “provide the best possible care”. They also all mention the importance of professional behaviour/ attitudes and personal conduct. However only one participant made an attempt at describing her understanding of this: “...professional behaviour is someone who is aware of their accountabilities, is of good character and displays values, beliefs and an attitude that puts the need of others before their own” (29/1/11).

If one theme appears more strongly than others, it appears to be that of professional identity. Participants indicated that they feel podiatry is worthy of professional status.

As stated by a participant “it is unique and serves a purpose for society” (25/1/11).

The main theme which became increasingly evident was “professional identity”, with all the sub themes being discussed, and for female participants, an aspect of this was the podiatrist’s role.

The participants highlighted the general lack of awareness that the public had regarding their profession, and this appeared frustrating.

One participant highlights what they think being professional constitutes, and how this is being affected: “Part of being a professional is knowing who you are and what you are there to do, as well as the patient knowing. As I didn’t

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even know what a Podiatrist truly was before I signed up to do the course, how are patients supposed to know” (2/12/10).

Another comment refers to the public “We have joined a profession as a podiatrist but many individuals have no idea what we do” (10/1/11).

The same participant details a situation with a patient who had previously been seen by a foot care assistant, who had described them as a “assistant nail cutter”; the participant then goes on to suggest that the patient may see podiatrists as “glorified nail cutters”.

Another aspect of identity described frequently by participants, was the use of the term “chiropodist” and the associated confusion this causes.

A participant describes ...”the name of our professional body “The Society of Chiropodists and Podiatrist” as all new graduates are only known as podiatrists I feel that it is unprofessional to still include chiropodist in our title”(2/12/10).

Post placement findings evolved from the experiences of placement, and overall the participants implied that their experience was positive and that they felt valued as professionals. ...”in general most patients are very pleased and happy with the service we provide, some even going as far as saying they couldn’t manage without us” (11/3/11).

Two participants state that they have changed their opinion with regards to professionalism, in respect of identity, in terms of title. The first describes a change in attitude towards using the term chiropodist: ...”I suppose I have changed in that I choose to say the term chiropodist for ease” (15/2/11).

When asked by a group member if she felt this affected her professional status, she disagreed and suggested that ultimately the name does not matter as the skills are the same.

The second participant states that her views have changed slightly but does not elaborate. She describes two challenging situations with patients, and states “people definitely do not see what we do as professional” (22/2/11).

All but one of the participants describes situations where patients challenged them with rude or abusive behaviour. This seemed to be due to the patients not understanding the podiatrist’s role and assuming for instance, that “we were only a nail cutting service” (3/3/11).

Confusion around title and professional role was illustrated by the following excerpts “I’m sure we have all been asked the question of what is the difference between a chiropodist and a podiatrist? Most patients relate to the term chiropodists and I feel this is very confusing… .” (10/1/11).

An example of a patient’s misunderstanding the professional title was explained by a participant describing when she collected a patient from a shared waiting area, asking:

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...”is anyone waiting for the podiatrist? then saying Chiropodist... followed by, are you here to get your feet done?”

(1/3/11).

Needless to say most comments around title, role and identity were made in the post placement discussion area. One particularly interesting remark was made by a new registrant who felt that they were treated with less respect because they weren’t specialised in a specific type of podiatry “I found that a podiatrist who specialised, for example in diabetes, rheumatology and paediatrics are looked at by patients as much more professional than your average Podiatrist” (24/2/11).

With respect to age as a subtheme of professional identity, one participant expressed frustration of people’s attitudes to her age and stated “they judge my age and assume I’m less capable” (24/2/11).

To illustrate the theme of professional standards, a participant described an incident with a challenging patient where she “struggled to maintain professionalism” also stating “I hope I acted in a professional manner, though it was hard!” (3/311).

It is appropriate here to reflect how difficult it is to separate out themes as the data above also fell into the ‘individual behaviour’ and ‘communication skills’ aspects of core values.

Another example of one’s core values being challenged is as follows “My only negative experiences are regarding patients who thought we were only a “nail cutting service”. I found this difficult in explaining to patients who were able to cut their own that we have more specialised roles…..From this the patient responded with rudeness and attitude” (3/3/11).

Discussion This research has highlighted the complex nature of professionalism as a subjective interpretation; this is clearly highlighted within the findings. Although the participant’s attitudes and opinions towards professionalism did not necessarily change after a working placement, they did however seem to evolve. Literature around “professional identity‟ was not reviewed until this theme had emerged from the raw data. To review in advance of the findings would have been impossible as at that point it was not known exactly what the research might produce.

It is also accepted that the limitations of this study include some degree of bias, as only the , first postings of both pre and post placement discussion were considered to be the purest; subsequent postings may have been influenced by or prompted by the first. Never the less the data does demonstrate a discussion within a group of new practitioners who reflect on their experiences.

Defining “professional identity‟ has proved as problematic as the initial defining of professionalism. Fagermoen (1997) has found that although professional identity is a frequent theme of discussion and concern, diverse meanings are linked to this concept. Fagermoen (1997) continues by commenting that a

review of literature revealed that professional identity was often addressed in terms of related concepts, especially that of professionalism. This coincides strongly with the findings of this research.

As with professionalism, much of the available and current literature (both research and review) regarding professional identity sits within the nursing and medical fields. Professional identity is often used to refer to a set of externally ascribed attributes that are used to differentiate one group from another.

Epstein (1978) has stated that professional identity represents the process by which the person seeks to integrate his various statuses and roles, as well as his diverse experiences, into a coherent image of self. Both of these definitions, although different, tie extremely well with the sub themes that were derived within this major theme of professional identity. The first definition of externally ascribed attributes can be closely associated with the outwardly looking picture that the general public often sees, whereas the second definition of statuses and roles can be closely associated with the participants themselves - and how those issues like the name confusion and the lack of knowledge of their job role ultimately affects their professional identity.

Job role and Name- chiropody vs. podiatry were the two sub themes that where discussed most often and were the only two sub themes that appeared both pre and post placement. Ellis (2009) explored the patient podiatrist relationship and noted that two main issues emerged, that of the confusion over the titles chiropodist and podiatrist, and confusion and ignorance about the scope of practice. The findings of this recent research were resoundingly similar to the findings of Ellis’s research; although her participants were experienced podiatric practitioners, as opposed to novice practitioners.

Confusion and ignorance of practice does not appear to be new. Skipper and Hughes (1984) interviewed podiatrists in the North American state of state of Virginia, and found that 50% of the podiatrists they interviewed believed that the general public lacked knowledge about what podiatry is and what podiatrists do; 34% were pessimistic about the public’s view of podiatry and believed they were not held in high regard. Twenty seven years later the findings of this research suggest that the same issues are still in evidence.

Few would disagree that a strong name that accurately reflects an organisation’s identity and purpose is a crucial requirement (Palmer 2010). As members will know, the name of the Society of Chiropodists and Podiatrists has been a sensitive and much debated issue for many years; the findings of this research suggest it is still a ‘hot topic’ for ongoing discussion.

At the outset of this paper it was identified that to remain registered, registrants must continue to meet various standards as described by the HPC. Many of these standards require registrants to demonstrate professionalism; one must wonder if podiatrists don’t have a clear sense of identity it must be increasingly difficult for them to recognise the behaviours and attitudes that indeed deem them

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professional. The HPC’s recent research on professionalism (HPC, 2011) included podiatry as one of the three professions explored.

Many of the participants were pre-registration students, and the findings concurred with this research in that participants were concerned that their behaviour was at all times seen by the public to be professional. The HPC paper commented that “ the emergence of professional identity therefore also appears to be a result of an interaction between the individual and experience, with some respondents basing it on their perceived qualities, some on experience and some on the statutory achievement of professional registration” ( HPC, 2011:37) The current study indicates that a tension remains within podiatric practice in respect of some patient’s perceptions of, and expectations of the role of the podiatrist. In itself, this may also be a challenge to the newly registered practitioner in establishing their own identity – in that the concept of professional identity developed during their undergraduate education is tested in the post registration world by the patients’ perceptions of what a podiatrist is and does, certainly at the level of ‘first destination post’ practice.

Conclusion This small, but relevant study explored new registrants’ personal opinions and experiences of professionalism as they undertook working placements as novice practitioners. It has shown their personal understanding of the concept of professionalism, and has demonstrated their willingness to act professionally, even in the face of challenging behaviours from service users. The research facilitated a sharing of experiences among these new practitioners, and it is hoped that the findings offer a unique contribution to the podiatry‐specific literature on professionalism, whilst contributing to the intra- and interprofessional discourse on the concept of professionalism.

Acknowledgements The authors are grateful to the level 4 Podiatry students of 2010-11 who participated in the research. Along with AS and JW, Niamh Burns, Gerard McGrane, Sarah Jane McKay, Claire Mulholland and Audrey Traill comprised the research team who conceived the research idea, developed the project and gave meaning and understanding to the data.

References Arnold, L., Shue, CK., Kritt, B., Ginsburg, S. and Stern, DT. 2005.

Medical students‟ views on peer assessment of professionalism. J Gen Intern Med [online] 20 September, pp.

819-824. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490208/?tool =pubmed [Accessed April 12th 2011] Ellis, M, JH. 2009. Professionalism within podiatric practice.

Podiatry Now. February, pp. 15-26.

Epstein, A. (1978) Ethos and Identity, Tavistock, London Fagermoen, MS. 1997. Professional Identity: values embedded in meaningful nursing practice. Journal of Advanced Nursing, [online] March, 25, pp. 434-441. Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.13652648.1997.1997025434.x/pdf [Accessed April 12th 2011] 10 | page

Finn, G. and Swandon, M. 2010. Does peer and self assessment correlate to the use of the conscientiousness index tool when evaluating professionalism in medical students?

Conference Proceedings of ASME Annual Scientific meeting, 1517th July, p.169 Health Professions Council. 2005. Standards of conduct performance and ethics. [online] Available from: http://www.hpc-uk.org/assets/documents/10002367FINALcopyofSCPEJuly2008.pdf [Accessed April 10th 2011] Health Professions Council. 2005. Standards of proficiency chiropodists and podiatrists. [online] Available from: http://www.hpcuk.org/assets/documents/10000DBBStandards_of_Proficiency_ Chiropodists.pdf [Accessed April 10th 2011] Health Professions Council. 2009. Continuing fitness to practice, towards an evidenced-based approach to revalidation. [online] Available from: http://www.hpcuk.org/assets/documents/10002AAEContinuingfitnesstoprac‐ tise-Towardsanevidence-basedapproachtorevalidation.pdf [Accessed April 11th 2011] Health Professions Council, 2011. Professionalism in healthcare professionals – research Report. www.hpc-uk.org Johnson, K. 2007. Protecting the titles „chiropodist‟ and „podiatrist‟: What powers does the HPC have? 10 (3) March, p.13 Mandy, P. 2008. The status of podiatry in the United Kingdom.

The foot, 18, May, pp. 202-205.

McLachlan, J., Finn, G. and McNaughton, RJ. 2009. The Conscientiousness Index: an objective scalar measure of conscientiousness correlates to staff expert judgements on student professionalism. Acad Med, 84:559-65.

Parmar, N. 2010. The name game. Podiatry Now. 13 (7) July, p.10 Skipper, J.K. and Hughes, J.E. 1984. Podiatry: Critical Issues in the 1980s. American Journal of Public Health. May, 74(5), pp.

507-508.

Saks M., and Allsop, J ( 2007) Researching Health – qualitative, quantitative and mixed methods. Sage publications, Los Angeles, USA and London, UK. ISBN 978-1-4129-0364-6 Ellis MJH (2009) Professionalism within Podiatric practice, Podiatry Now 12 (2) 15-26 Van de Camp, K. Vernooij-Dassen, MJFJ. Grol, RPTM. And Bottema ,BJAM. 2004. How to conceptualise professionalism: a qualitative study. Medical Teacher, 26(8) pp. 696-672.

Dr Mairghread JH Ellis FHEA BSc MSc DPod, Programme Leader, BSc Hons Podiatry, Division of Dietetics, Nutrition, Biological Sciences, Physiotherapy, Podiatry and Radiography, School of Health Sciences, Queen Margaret University EH21 6UU mellis@qmu.ac.uk *Corresponding author

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2012 Annual General Meeting Nominations for National Office President - One Nomination Mrs. Heather Bailey East Anglia Branch

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The Problem with Plantar Fasciitis Beverley Wright MInstChP, BSc (Hons) PGCE, PGDip Most of us have heard about Plantar Fasciitis, which is a common cause of heel pain, and although treatments are usually conservative, they can take up to 2 years to achieve some sort of resolution.

Heel pain is a common presenting symptom among clients/ patients, which needs to be differentiated from other heel pain complaints. A physical examination can usually indicate the location of pain and a guide to a proper diagnosis. The most common diagnosis is plantar fasciitis, which can lead to medial plantar heel pain, especially if the clients/ patients complain of pain upon weight‐bearing first thing in the morning or after long periods of rest (Harkless & Krych, 1990; McRae1990; Thompson & Gibson, 2002).

However, there are many other causes of plantar heel pain, such as calcaneal stress fracture resulting from an injury due to an increase in activity, or activities on hard surfaces; nerve entrapment (also involves burning, tingling, or numbness); neuromas and plantar warts (Turner & Merrimen, 2005). Achilles tendinopathy is another common condition that causes posterior heel pain, and other tendinopathies demonstrate localized pain to the insertion sites of affected tendons (Lorimer et al, 2002).

Haglund deformity (posterior heel pain), which is a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease (a calcaneal apophysitis in children) (Lorimer et al, 2002). Medial midfoot heel pain, which may be due to various reasons, including continued weight bearing; or as a result of tarsal tunnel syndrome, caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome, which projects lateral midfoot heel pain that occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints (Lorimer et al, 2002, Turner & Merrimen, 2002; Turner & Merrimen, 2005; McPoil et al, 2008).

It is therefore very important to differentiate among the many causes of heel pain by going through the client/ patient’s medical

history, lifestyle activities and conducting a physical assessment/ examination. The examination can be accomplished by palpating the origin of the plantar fascia along the medial plantar aspect of the calcaneus and if the area is painful it is usually consistent with plantar fasciitis, or as it is sometimes referred to as heel spur syndrome (Thompson & Gibson, 2002). However, heel spur syndrome does not cause heel pain, despite a bone spur appearing on radiographs (x –rays) at the point of insertion of the plantar fascia (Harkless & Krynch, 1990).

Once the mechanical aetiology has been established and plantar fasciitis is diagnosed, what do we do with clients/ patients complaining of it?

The initial treatments would include the following: ice, Achilles tendon stretches, advice regarding good supportive shoes, exercises for intrinsic muscles of the foot, inserting anti-shock podiatry heel supports, use of memory foam insoles in shoes, or cushioned medial heel wedges or pads, and non-steroidal and anti‐inflammatory drugs (NSAIDs) (Kenrick, D. J & Bishop, P.S, 1998; Thompson & Gibson, 2002; McPoil et al, 2008).

If symptoms persist or there has not been any improvement within a few weeks of diagnosis, x-rays or imaging may be indicated. Further NSAIDs or short acting steroids may be given such as injecting corticosteroids (i.e.Dexamethasone 0.4% or acetic acid 5%). An assessment for orthotics for forefoot varus and excessive pronation of the subtalar joint, which is commonly seen among plantar fasciitis sufferers, may be required (Thompson & Gibson, 2002; McPoil et al, 2008). Other options may be considered too, which include acupuncture, taping (for immediate relief such as, bow strapping that supports the plantar fascia), eccentric step exercises or get the client/ patient to wear a night splint (Lorimer et al, 2002; Thompson & Gibson, 2002; Turner & Merrimen, 2005).

Medical Doctors/ General Practitioners (GP’s) and Chartered Physiotherapists may prescribe to other methods of treatment used in the management of plantar fasciitis, such as Alfredson's heel drop protocol, deep tissue massage to the foot (McPoil et al, 2008). Physiotherapists are known to check the fascial line from the heel through calves and hamstrings, and remove any fascial restrictions. If there is no further success Johnson (2011) suggests therapists continue up the fascial line from gluteals, erector spinae, neck and occiput and again removing any restrictions. A Myofascial release may be performed to the plantar fascia itself, where it is worked as deeply as possible within the client/ patient's pain threshold. Clients/ patients may also be asked to increase their speed of gait where they have to focus on achieving a conscious heel strike as they walk (McPoil et al, 2008; Johnson, 2011). The evidence to support the success and downfalls of many commonly used treatments for heel pain and plantar fasciitis has been outlined in the McPoil et al (2008) study.

In addition, it may be necessary to treat the pelvis first, before going anywhere near the feet, as many client/ patients with plantar fasciitis have a rotated pelvis. This may involve mobilising the lumbar spine, stretching the tibialis posterior and toes into extension, which also helps to activate the nervous system (McPoil et al, 2008; Johnson, 2011).

So could something else be driving the condition: is it the thoracic spine? A very high foot arch? An overactive calf muscle?

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injecting botulinum toxin type A instead of using corticosteroid injections (Babcock et al, 2005; Diaz-Llopis et al, 2011).

Botulinum toxin A injection for plantar fasciitis has indicated towards significant improvements in pain relief and overall foot function at both 3 and 8 wks after treatment (Babcock et al, 2005). This was also found in Diaz-Llopis et al (2011) study after concluding the results following one month and six month trials.

A more novel approach from Brook, et al (2012) study on the use of Pulsed Radiofrequency Electromagnetic Field Therapy (PRFE) to reduce the pain associated with plantar fasciitis. PRFE therapy worn on a nightly basis appeared to offer a consistent downward pain and a simple, drug-free, non-invasive therapy to reduce the pain when compared to medication intervention (Brook, et al, 2012).

Tight calf muscles can make it difficult to flex your foot and move the toes up towards the shin (Lorimer, et al, 2002). The treatments would then involve addressing the calf, talocrural, subtalar restrictions. It may also be useful to check the glute medius strength and endurance by using golf/ tennis balls on the plantar surface. A lack of hip extension and internal rotation on the same side of the hip will strain plantar fascia, so this may need to be examined (Lorimer, et al, 2002; McPoil et al, 2008; Johnson, 2011). This also suggests a neuro-orthopaedic condition that is the result of nerve irritation (as in tennis and golfers elbow), so it may also be necessary to refer the client/ patient to the GP/ physiotherapist to examine and treat the nerves associated (usually higher up in lumber/sacrum) (McPoil et al, 2008).

Surgery may be required after months of unsuccessful treatments, such as a Gastrocnemius recession, which can be performed to lengthen the calf muscles and increase the motion of the ankle to take the stress off the plantar fascia. In extreme cases the plantar fascia is divided (Steindler’ release), but this could make the foot dysfunctional (Thompson & Gibson, 2002). Other surgical procedures such as Shockwave Therapy (under anaesthesia) and Partial Plantar Fasciectomy (removal of injured part of plantar fascia) may improve the symptoms of plantar fasciitis.

There are many treatments to support and improve plantar fasciitis. Laser therapy, metatarsal pads, ultrasound, taping and a kinaesthetic approach to name a few, are some of the treatments employed to either relieve heel pain or help improve the symptoms of plantar fasciitis; but it maybe more beneficial for the client/ patient to make changes to their lifestyle.

Plantar fasciitis is a common occurrence in the middle aged, but can occur at anytime in life (McRae, 1990). It does tend to affect sports athletes, particularly runners (repetitive impact activity), and those engaged in new or increased activity, but it is certainly very prevalent in individuals who are overweight (obese). Therefore, advice or referrals to support client/ patients in helping them make positive health changes in their lives may be required; in conjunction with the treatments prescribed (McRae, 1990; Thompson & Gibson, 2002).

In recent years research studies have been looking at other treatments for chronic cases of plantar fasciitis, which involves

There appears to be so many different and varying treatments for plantar fasciitis, which gives practitioners plenty of choice to make the right (and evidence-based) decisions for the treatments they give to their clients/ patients. Although, many practitioners will continue to use the tried, tested and trusted methods that they have always used. However, treatments are continually evolving and being researched and this, it is hoped, will eventually help both acute and chronic plantar fasciitis sufferers in the future.

References Babcock MS, Foster L, Pasquina P, Jabbari B. 2005. Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil. 2005 Sep;84(9):649-54.

Brook J, Dauphinee DM, Korpinen J, Rawe IM. 2012. Pulsed Radiofrequency Electromagnetic Field Therapy: A Potential Novel Treatment of Plantar Fasciitis. J Foot Ankle Surg. 2012 Jan 30.

Diaz-Llopis IV, Rodriguez-Ruiz CM, Mulet-Perry S, Mondejar-Gomez FJ, Climent-Barbera JM, Cholbi-Llobel F. 2011. Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months. Clin Rehabil. 2011 Dec 1.

Harkless, LB & Felder-Johnson, K. 1998. Foot & Ankle Secrets. Kenrick, D. J & Bishop, P.S. Podiatric Sports Injuries pp.111. Hanley & Belfus.

Philedelphia.

Harkless, LB & Krych, SM. 1990. Handbook of Common Foot Problems.

Churchill Livingstone. New York.

Johnson, J. 2011. Chartered Physiotherapist.

Lorimer, D., French, G., O’Donnell, M & Burrow, GJ (ed). 2002. Neale’s Disorders of the Foot 6th Ed. Churchill Livingstone. Edinburgh.

McPoil, TG, Delitto, A, Dewitt, J., Ferland, A., Fearon, H., MacDermid, J., McClure, P., Shekelle, P., Smith, Jr., R., & Torburn, L. 2008. Heel Pain Plantar Fasciitis: Clinical Practice Guidelines Linked to the International Classification of Function, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008:38(4):A1-A18. doi:10.2519/jospt.2008.0302.

McRae, R. 1990. Clinical Orthopaedic Examination 3rd Ed. Churchill Livingstone. Edinburgh.

Merriman, LM & Turner, W (ed). 2005. Clinical Skills in Treating the Foot 2nd Ed. Churchill Livingstone. Edinburgh.

Merriman, LM & Turner, W (ed). 2002. Assessment of the Lower Limb 2nd Ed. Churchill Livingstone. Edinburgh.

Thompson, CE & Gibson, JNA. 2002. 50 Foot Challenges Assessment & Management. Churchill Livingstone. Edinburgh.

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The Use of Alcohol Gels for Hand Hygiene for Health Professionals – Electronic Literature Search Anne Todd MInstChP, BSc, Pod RMT, MCThA To begin my search for an appropriate article, I started with the subject resources section when on the library section of the QMU portal page. Clicking on Podiatry brought up several databases – I recognised the Cumulative Index to Nursing and Allied Health Literature (CINAHL) as a good quality database so started with that. I had previously visited MEDLINE and others but I found the layout of CINAHL excellent for clarity of searching and great for being able to instantly save or email the full abstract.

The subject librarian, Laurie Roberts, had also endorsed it. My use of search items was simplified to hygiene and alcohol gel as these were the main parts of the subject area. Without allocating the words to any specific search fields, 8 results were returned.

After having a quick look at the article titles, I tried again including the additional search phrase ‘health professionals’ – no results were found so I resumed my original 2 part word search.

I chose the American Journal of Infection Control (AJIC) article

by Hilburn et al (2003) as the title seemed to most aptly fit the information I was looking to include. This was befitting of Tarling and Crofts (1998) assertion that any research article title should be informative and precise, yet it was noted that details of the methods and approached used were absent. Despite not having a disclaimer, the CINAHL database is a renowned international database for nurses (suggesting likely usefulness in the podiatry field) (Kane 2004), with information on their links with many academic institutions and hospitals/medical establishments. With regard to ownership, on researching the AJIC further via a search engine, I was able to see that it does contain a disclaimer on the site and is the official journal of the Association for Professionals in Infection Control and Epidemiology. Their website holds peerreviewed articles and hosts a certification page with detailed information on how they go about their work. No disclaimer is given, but there is a goals/mission section and they have stated clearly that they do not endorse commercial products. Silberg, Lundeberg and Musacchio (1997) list disclosure as one of the criteria to be included in websites, stating that sponsorship, funding details and the like should be admitted to in the hope of increased integrity of internet sites.

Although the full text article was not immediately available, the Link Source icon provided directed me to Science Direct, where I could view the pdf article. Here, I could see full details of what appeared to be a randomised controlled trial (RCT) including; sample size, methods of data collection, results and a conclusion. Babu (2008) places RCTs at the top of the research hierarchy, a form of quantitative research usually testing a specific hypothesis that typically employs a fairly large population size. It was worth mentioning, though, that the type of research used was not actually stated in the paper or abstract, also, if it was an RCT there was no ‘blinding’ of any participants involved. The article was written in the passive voice, such an objective style of a quantitative report being appropriate according to Polit, Beck and Hungler (2001). The article was deemed to be of barely adequate currency, being published in the last 5 years, with the 14 | page

research being conducted 8 years ago.

Whilst acknowledging the absence of the Health on the Net Foundation’s badge of support as stressed by Kiley (2003), and bearing in mind the difference between British and American research, I considered the article to be of adequate length, well written with clearly presented data suggesting inferential statistics that proved a significant decrease in infection rates.

I would expect other student podiatrists, certainly at initial Level 1, to find the piece useful as the product it endorsed (alcohol gel) is of low-cost, readily available and extremely practical to use in a clinical setting. It may be that time is a factor in deterring frequent hand washing when many patients have to be attended to repeatedly. The convenience of hand gels may then make compliance with hygiene procedures more likely. The information would be easily summarised, if perhaps not fully analysed, and presented easily to other students. Babu (2008) mentions components of basic concepts required in clinical research that the AJIC article contains: minimisation of risk to patients, cost effectiveness and direction of need are 3 of these.

Hillburn et al (2008) emphasise the improvement of patient safety and care through reduced infections, as well as the associated decrease in expenses of resources unable to be refunded. Read (1976) states the hands of the clinician as one item of consideration in the pre-operative cleansing routine declaring the need for clean nails particularly - and reports also the many benefits of alcohol as a solvent. The evident benefits to the health institution and their reputation when patient suffering is lessened are rightly mentioned to further back up the recommendations. Additionally, Hillburn et al (2003), make the claim that using an emollient based gel is less likely to lead to skin irritations and dryness of hands in health professionals than constant washing in soap and water. In the conclusion section a literature review is given, and the point is mentioned about the link between hand washing and transmission of nonsocomial pathogens, where compliance is highlighted as the main factor and alcohol hand gels being the most practical way of improving this issue. Greenhalgh (2006) draws attention to the difficulty of changing practice from evidence, claiming that new strategies often take years to be fully implemented. Moreover, Keenan and Redmond (2002), underline the complexity of evidenced based practice and how knowledge is constantly required to effect best clinical practice (EBP), emphasising that it is in the best interests of podiatrists to practice in a responsible manner with regard to EBP and thereby exert control over their clinical working.

References: Babu, A. N. 2008. Clinical Research Methodology and Evidencebased Medicine: The Basics. Kent: Anshan Ltd. (UK).

Greenhalgh, T. 2006. How To Read A Paper: The Basics of Evidence Based Medicine. Oxford: Blackwell Publishing.

Hilburn, J., Hammond, B. S., Fendler, E. J. and Groziak, P. A. 2003. Use of alcohol hand sanitizer as an infection control strategy in an acute care facility. American Journal of Infection Control, 31 (2) April, pp. 109-116. Available from:

ARTICLE

http://www.sciencedirect.com/science?_ob=MImg&_imagekey =B6W9M-488NBFT-81&_cdi=6686&_user=1103673&_orig=search&_coverDate=04% 2F30%2F2003&_sk=999689997&view=c&wchp=dGLbVtzzSkWb&md5=c9817c584ac64e60eaf75f992e162c6b&ie=/sdarti cle.pdf Accessed {09.01.09}

Thei rfeet

Kane, M. 2004. Research Made Easy in Complementary and Alternative Medicine. Edinburgh: Churchill Livingstone.

Keenan, A. and Redmond, A. C. 2002. Integrating Research Into the Clinic – What Evidence Based Practice Means to the Practising Podiatrist. Journal of the American Podiatric Medical Association, 92 (4) February, pp. 115-122.

safe in your hands

Kiley, R. 2003. Medical Information on the Internet – A Guide for Health Professionals. 3rd ed. Edinburgh: Churchill Livingstone.

Polit, D. F, Beck, C. T. and Hungler, B. P. 2001. Essentials of Nursing Research Methods, Appraisal and Utilisation. 5th ed.

Philidelphia: Lippincott.

Read, P. J. 1978. An Introduction to Therapeutics for Chiropodists. 2nd ed. Worcester: The Actinic Press Ltd. Silberg W., Lundeberg G. D. and Musacchio, R. A. 1997.

Assessing, Controlling and Assuring the Quality of Medical Information on the Internet, Caveant Lector et Viewor – Let the Reader and Viewer Beware, Journal of the American Medical Association, 277 (15) pp 1244-1245.

Tarling, M. and Crofts, L. 1998. The Essential Researcher’s Handbook. London: Bailliere Tindall.

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Podiatry as a Profession: My path to becoming a Podiatrist and my experience as a newly Qualified Practitioner Part 3 Deirdre O’Flynn BSc, Podiatry This month I would like to share with you some interesting cases I have come across over the last few weeks.

A 50-year old male priest presented into our clinic some months back complaining of pains in his feet. Upon examination of both feet, the skin on the heels and toes were pitted, white and shiny which were moist to the touch. His socks were also wet and there was a strong smell of perspiration. He has excessive sweating on his head, neck and underarms. He explained that this has been a problem for him since he was twelve years of age. Mr X is an active person, who goes out walking frequently every week. A detailed medical history was taken from the patient and he was asked whether there were any contributing factors that increase sweating for him. For example diseases such as neurologic, metabolic or other systemic diseases that could bring about the excessive sweating or triggers such stress, increased heat, certain food and drinks. Mr X had no history of diseases but when he was sent to Africa with the missionary’s he found the heat and the sweating unbearable. Mr X had been to a doctor some years regarding the sweating, he concluded that he had weakened sweat glands. Mr X had spent years buying lotions and potions to try and combat this. He had sweat absorbing insoles in his shoes but he found them not very effective. He had also tried herbal tonics with no positive results. A diagnosis of Hyperhidrosis along with Bromidrosis was made.

upon examination of both feet there was a minor improvement since he had attended the clinic previously.

The patient was advised Iontophoresis should be the next option for him at this stage.

Iontophoresis is used in clinics where strong antiperspirants have been unsuccessful in controlling excessive stress. It is a treatment that should be considered before injections and surgery. It works by giving the skin a mild electrical current where there is excessive sweating. Tap water is used in transferring the current to the skin. Mr X came in for treatment every second or third day for up to ten sessions. The treatment took 30 minutes in total for both feet. After the ten sessions Mr X was advised to return after a few months for 1- 2 more treatments. This should be done every few months to prevent the hyperhidrosis from returning. On the day of the treatment tap water was placed in two trays. Two metal plates (electrodes) were placed into the trays. The metal plates were then connected to cables, which allowed the current to pass through. Mr X was asked to place his feet into the trays completing the circuit. A switch was used to regulate the mild electrical current. Initially the current is slightly stronger but as Mr X received more treatment he was more sensitive to the current and it is reduced slightly. Mr X finished

After discussing with Mr X the possible treatments available, it was initially decided for him to try an antiperspirant deodorant. He was given Anhyrol Forte which was to be applied at night before bed and washed off in the morning. Mr X was advised to return in two weeks for a review.

Mr X returned two weeks later and

16 | page

Fig.1

Fig.2

ARTICLE

his course of ten treatments on Friday last. I was very pleased with the results. On examination of both feet the excessive sweating had stopped and the skin was returning to good healthy pink colour. The pitted and soggy skin had been reduced dramatically. Mr X was very pleased with the results. Planter hyperhidrosis had affected him for a good part of his life and he thought there could be no cure. I am very interested in seeing Mr X again in two months for his follow treatment. It will be exciting to see if the hyperhidrosis stays at bay (Iontocentre.2011)

return to the clinic three weeks after her initial visit for possible further slight debridement and review of both feet. I am looking forward to seeing my patient Mrs Y and hopefully she will adhere with all my advice and I will see positive results.

Mrs Y presented into the Clinic in Midleton last week. Mrs Y is a 50 year old lady carrying extra weight. She had a lot of discomfort in her feet especially around her heels. On observation a deep crack was seen that was running into the healthy pink tissue on the posterior of the heel (See Fig 2). The excess weight was putting more pressure on the fatty pad under her foot which caused the skin to expand sideways resulting in splits and cracks around the heel. Mrs Y also had been wearing open back shoes and her feet were not supported around the heels. I took a detailed medical history of Mrs Y and asked her about her foot care. She was not diabetic or had psoriasis which could be a contributory factor to the condition presented. She had informed me due to the excess weight she was unable to bend down to apply emollient on a regular basis. Her skin was very anhidrotic.

My sort term treatment plan involved, laying the patient flat on her stomach so I could get to the heels easier. Both feet were applied with pre and post op antiseptic. I extensively reduced the callus using a 10 blade. I then applied a wound healing cream called Amerigel (DermNet NZ.2009).

References:

Amerigel is a product we use fairly often in the clinic it contains oaken which is an oak extract. The tannins found in the extract encourage the natural healing of wounds, cuts sores, ulcers etc.

(Amerigel.2011). Over the amerigel I applied a layer of fleecy web and covered this with mefix. The patient was advised to leave this in place for three days. I recommended that Mrs Y use a cream with 10 % urea. Her husband would be able to apply this for her on a daily basis. I also advised Mrs Y to bathe her feet twice a week and to wear footwear with an enclosed heel. Mrs Y is to

Can

In the next article I will discuss a condition and treatment that presented into our clinic this week. From the photograph’s below you may wish to suggest the condition and the treatment you would give. To comment please email bernie@iocp.org.uk or join me in our forums to discuss this www.iocp.org.uk Amerigel.2011. Advanced skin and wound care products.

[Online] Available from : http://www.amerigel.com/hcphome.html [Accessed 8th of February 2012].

DermNet NZ.2009. Cracked Heels. [Online]Available from: http://dermnetnz.org/scaly/cracked-heels.html [Accessed 8th of February 2012].

Fig.1.2012. Photograph Cracked Heel. Taken from Midleton foot clinic.

Fig.2.2012. Photograph Cracked Heel. Taken Midleton foot clinic.

Iontocentre.2011. Iontophoresis specialist. [Online] Available from: http://www.iontocentre.com/index.html?gclid=CJhprLiia4CFcpB4QodMG5m5w [Accessed 8th of February 2012].

Iontocentre.2011. Iontophoresis specialist. [Online image] Available from: http://www.iontocentre.com/index.html?gclid=CJhprLiia4CFcpB4QodMG5m5w [Accessed 8th of February 2012].

Dermaproblems.com. 2010. Pitted Keratolysis. [Online image] Available from: http://dermaproblems.com/tag/legs-problems/ [Accessed 8th of February 2012].

Sweating.ie.2004.Anhydrol Forte. [Online Image] Available from: http://www.sweating.ie/anhydrol_forte.htm#. [Accessed 8th of February 2012].

You

Help?

page | 17

INFORMATION

Is your First Aid Certificate up to date?

We would like to remind members that the HPC standards of practice 2b4 state that all registrants "be able to use basic life support skills and to deal safely with clinical emergencies".

Failure of compliance with HPC standards of practice could lead to an allegation of ‘fitness to practice being impaired’.

Also, the Health and Safety Executive point out that ; “The Health and Safety (First-Aid) Regulations 1981 require employers to provide adequate and appropriate equipment, facilities and personnel to ensure their employees receive immediate attention if they are injured or taken ill at work. These Regulations apply to all workplaces including those with less than five employees and to the self-employed.

Detailed information can be found in: First aid at work. The Health and Safety (First Aid) Regulations 1981. Approved Code of Practice and guidance.

The HSE also go on to say: “ The Health and Safety (First-Aid) Regulations 1981 require employers (this includes the SelfEmployed) to provide suitable first‐aid equipment, facilities and personnel so that immediate assistance can be given to employees if they are injured or become ill at work. Regulation 3(2) states that in order to provide first aid to injured or ill employees, a person isn't suitable unless they have undergone

Sheffield Training Centre

18 | page

the right training and qualifications approved by HSE and any additional training if required.”

The Institute Emergency First Aid at Work Course is an intensive and very costeffective full day HSE approved course, that fully satisfies the requirements of places of employment with up to 50 persons and lasts for 3 years. As the potential for Anaphylaxis and Cardiac collapse is higher in healthcare situations, especially so for members undertaking Local Anaesthesia or other advanced procedures, the course includes additional training in Adrenaline use and advanced airway management including Oropharangeal (Guedel) Airways and Bag Valve Masks. Courses can accommodate up to 12 people and are taught and assessed by the Institute’s Faculty of Education own HSE recognised trainer.

Please telephone 01704 546141 to register your interest.

Note to Branch Secretaries: If enough members of your branch request, we will be happy to organise first aid training locally. Please contact Head Office to make arrangements.

INFORMATION

IO C P n e g o t ia t e s a n e x c lu s iv e o p p o r t u n it y f o r m e m b e r s .

Th e In s t it u t e r e c e n t ly t o o k s ig n ific a n t s t e p s t o w a r d s e n s u r in g t h a t o u r m e m b e r s a r e p la c e d in a fa v o u r a b le p o s it io n w h e n it c o m e s t o p o d ia t r y r e fe r r a ls fr o m G Ps .

F r o m A p r il 2 0 1 2 p a t ie n t s r e c e iv in g o n e o f e ig h t t y p e s o f c o m m u n it y a n d m e n t a l h e a lt h s e r v ic e s in En g la n d w ill b e a b le t o b e g iv e n a c h o ic e r e g a r d in g a c c e s s t o t h e ir c a r e o r s u p p o r t fr o m a p r iv a t e h e a lt h p r o v id e r o r v o lu n t a r y o r c h a r it a b le o r g a n is a t io n , n o t ju s t t h e N H S. Th e s e s e r v ic e s , w h ic h in c lu d e p o d ia t r y , r e p r e s e n t a b o u t £ 1 b n o f t h e N H S's £ 1 1 0 b n a y e a r a c t iv it y .

In a n t ic ip a t io n o f t h is d e v e lo p m e n t t h e In s t it u t e h a s n e g o t ia t e d t h e r ig h t s t o o ffe r o u r m e m b e r s t h e o p p o r t u n it y t o p r o m o t e d e t a ile d in fo r m a t io n a b o u t t h e ir p r a c t ic e s t o t h e ir lo c a l G P p r a c t ic e s v ia t h e n e w D X S Re fe r r a ls D ir e c t d ir e c t o r y s y s t e m . It is t h e U K ’s fir s t fu lly a u t o m a t e d h e a lt h c a r e r e fe r r a l s y s t e m b e t w e e n G Ps a n d Po d ia t r is t s . Th e s y s t e m is in t e g r a t e d in t o t h e Ele c t r o n ic H e a lt h Re c o r d a n d t h is m a k e s it e a s y fo r G P’s a n d n u r s e s t o a c c e s s t h e r ig h t in fo r m a t io n a t t h e r ig h t t im e - d u r in g t h e p a t ie n t c o n s u lt a t io n a n d a t t h e p o in t o f d ia g n o s is .

Re c e n t r e s e a r c h s h o w s t h a t G P s t ill g e n e r a t e a m a s s iv e 4 6 % o f a ll r e fe r r a ls !

D X S R e f e r r a ls D ir e c t is a n e w fe a t u r e fr o m D X S. D X S is a c lin ic a l in fo r m a t io n s u p p o r t s y s t e m t h a t h a s b e e n u s e d b y G Ps a n d n u r s e s t h r o u g h o u t t h e U K fo r m o re t h a n t e n y e a r s n o w . To d a t e t h e D X S s o ft w a r e is in t e g r a t e d in t o t h e e le c t r o n ic p a t ie n t r e c o r d s y s t e m s a n d p r a c t ic e m a n a g e m e n t s y s t e m s o n t h e c o m p u t e r d e s k t o p s o f 2 2 ,0 0 0 G Ps , 1 6 ,0 0 0 n u r s e s a n d 5 ,5 0 0 r e t a il p h a r m a c ie s in t h e U K .

H o w D X S R e f e r r a ls D ir e c t w o r k s Ea c h t im e a G P o r a n u r s e e x a m in e s a p a t ie n t a n d r e c o r d s a d ia g n o s is in t o t h e e le c t r o n ic p a t ie n t r e c o r d s y s t e m , D X S in s t a n t ly filt e r s a n d a n a ly s e s t h e in fo r m a t io n . Th e m o m e n t a d ia g n o s is is r e c o r d e d w h e r e t h e p a t ie n t c o u ld b e r e fe r r e d t o a p o d ia t r is t , D X S Re fe r r a ls D ir e c t is a c t iv a t e d o n t h e c o m p u t e r d e s k to p a n d a s p a r t o f t h e n o r m a l w o r k flo w p r e s e n t s a d ir e c t o r y o f t h e Po d ia t r is t s in t h e a r e a q u a lifie d t o t r e a t t h e d ia g n o s e d c o n d it io n . It is b o t h c o n d it io n s p e c ific a n d a r e a s p e c ific .

In c r e a s in g P a t ie n t C h o ic e D X S Re fe r r a ls D ir e c t m a k e s it e a s y fo r t h e d o c t o r s a n d n u r s e s t o in v o lv e t h e ir p a t ie n t s ’ in t h e r e fe r r a l p r o c e s s . To p r o v id e t h e p a t ie n t s w it h m o re c h o ic e , t h e y s im p ly p r in t - o u t t h e Re fe r r a ls D ir e c t D ir e c t o r y a n d d is c u s s t h e o p t io n s w it h t h e m . Th e D ir e c t o r y is c o n d it io n s p e c ific a n d a r e a s p e c ific , s o it p r o v id e s p a t ie n t s w it h m o r e c h o ic e a b o u t t h e p o d ia t r is t s in

S p e c ia l O f f e r f o r IO C P M e m b e r s Th e In s t it u t e b e lie v e s t h a t t h is s e r v ic e w ill b e b e n e fic ia l t o a ll m e m b e r s a n d h a s n e g o t ia t e d a s p e c ia l a n n u a l r a t e w it h D X S Re fe r r a ls D ir e c t o f £ 4 0 p e r m e m b e r, in s t e a d o f t h e n o r m a l r a t e o f £ 6 0 p e r annum !

G e t t in g lis t e d is e a s y To get listed in the DXS Referrals Direct Directory on the computer desktops of GPs in your area, simply telephone the IOCP on 01704 546141 for an application form or apply on-line directly through the DXS Referrals Direct at www.dxsrd.com

To

Chris Maggs (Sheffield Branch)

On Winning the City of Guilds Medal for Excellence Chris completed The Institute of Chiropodists and Podiatrists Level 4 Higher Professional Diploma in Foot Health Care and Practice in conjunction with The City & Guilds of London Institute for Excellence and is now in the running to win one of the prestigious Lion Awards; this includes the ‘People’s Choice Award’, voted for by the public.

U n it 6 a A b b e y B u s in e s s P a r k ,

R e f e r r a ls D ir e c t R IG H T P L A C E , R IG H T T IM E

M o n k s W a lk , F a r n h a m ,

IOCP_Chiropody

S u rre y G U 9 8 H T .

Saturday 28th April 2012

Autoclave Servicing at Southport AGM To Book an appointment please contact MDS Medical on 01933 462636 page | 19

INFORMATION

Vetting & Barring Scheme and Criminal Records Regime Review recommendations - Latest Update Questions and answers relating to the re-modelling of the VBS. 1. Why are you looking to scale the VBS back?

Barring arrangements

Under the previous arrangements proposed, some nine million individuals would have been required to register under the Vetting & Barring Scheme, as their work fell within the definitions of the prescribed work (i.e. regulated or controlled activities involving children or vulnerable adults).The Government has conducted a review of these proposals and come to the view that they were not proportionate. The Bill therefore amends the Safeguarding Vulnerable Groups Act, which provides the framework for the vetting and barring scheme, to redefine the scope of the scheme (i.e. reduce the range of posts that fall within 'regulated activity' and scrap 'controlled activity' altogether) so that only essential posts (from a public protection perspective) will fall within its requirements. This significantly reduces the number of individuals affected by the scheme.

5. What are the changes being made?

2. How will employers and other registered bodies understand who falls into regulated activity and who does not?

6. So what is happening to 'regulated activity'?

Appropriate and timely guidance about the remodelled scheme will be provided before any changes commence.

We will continue to use Government websites to ensure that appropriate information is available to relevant audiences.

3. Will you issue guidance about safe recruitment practices, such as still being able to request criminal records checks even where barring information will not be available?

Yes. The Department for Education will update its sectoral guidance for education settings, "Safeguarding Children and Safer Recruitment in Education". The aim will be to provide advice that is as clear and brief as possible.

This can also be used as best practice guidance for other settings in the children's sector.

4. Why are you changing the definition of regulated activity?

The Government considers that the scope of regulated activities under the SVGA was too wide and covered too many people. We wish to guard against discouraging genuine people who wish to volunteer for work with children.It is for employers and organisations using volunteers to ensure safe recruitment, training and supervision, rather than relying wholly on state-regulation.

Allowing people to work under supervision emphasises the shared nature of protection arrangements.

20 | page

We have redefined "regulated activity" (paid or voluntary work that involves contact with children or vulnerable adults) to ensure that only those who have close, regular or unsupervised contact will be covered by the new arrangements. Controlled activity did not include the same level of close contact as regulated activity, this was an unnecessary burden on many individuals, so government has scrapped the notion of controlled activity altogether.

Those working in regulated activity will still be subject to the barring regime but we propose to abolish the requirement to register with the Scheme for continuous monitoring. Where a position involves access to children or vulnerable adults employers and voluntary bodies will still be able to request CRB checks, which will include relevant criminal record information The definition of 'regulated activity' will be narrowed under these amendments, meaning the range of posts subject to barring decisions will be reduced. As we will also be scrapping the previous requirements for registration and continuous monitoring, the overall burden on those posts still within the scope of the new arrangements will be greatly reduced and, we believe, more proportionate. A smaller (and more proportionate) group of roles will now be defined as regulated activities.

7. What is happening to 'controlled activity'?

The concept of 'controlled activity', where an individual had some contact with children and vulnerable adults, but not as intense, frequent or regular as that deemed a regulated activity, will be scrapped under these amendments. Previously, controlled activity would have covered posts like catering staff in further education colleges and hospital records clerks, for example. Employers would have had to check people applying for these posts but could have employed them if appropriate safeguards were put in place.

8. Will the new scheme apply to volunteers?

Yes. The refocused scheme will focus on the activity being carried out, rather then the employment status of the individual carrying it out.Volunteers who are undertaking the newly defined regulated activity will still be able to obtain an enhanced criminal records disclosure and the organisation employing them will be required to check their barred status before the individual commences working in

INFORMATION

regulated activity. Some posts working with vulnerable groups, but which fall outside regulated activity, will remain eligible for enhanced CRB checks. This will help employers to make an informed decision about employing someone, either paid or unpaid.

9. Will volunteers now have to pay?

As now, volunteers will not be required to pay for criminal records checks. The opportunity to opt into the online checking service and pay a subscription fee is voluntary. The level of that subscription fee has yet to be determined but it will certainly be cheaper than a new CRB check. The decision on whether volunteers will have to pay for this service is still under consideration. Abolition of registration and monitoring requirements.

10. What are the specific changes being made?

Those engaged in roles which fall with the scope of the new arrangements will not be required to register and there will be no continuous monitoring arrangements.

11. What types of post will not now fall under Regulated Activity that would have been covered by the previous scheme?

Examples of people who will no longer fall within regulated activity include supervised volunteers and

external contract workers such as plumbers, electricians or window cleaners, and receptionists working in care homes.

12. Will similar changes be made in Scotland and Northern Ireland?

Justice and criminal records matters are devolved functions and Scotland and Northern Ireland have separate arrangements. Nonetheless, it is important that arrangements across the UK are all in step and there are no gaps in public protection terms. With the agreement of the Northern Ireland Assembly, the Bill makes parallel amendments to the vetting and barring scheme in Northern Ireland so that it continues to be aligned with that in England and Wales. Scotland is maintaining its own Protection of Vulnerable Groups (PVG) scheme.

The full article including terms of reference, the formal Government response to both phases, along with the full Criminal Records Regime reports can be viewed at link:http://www.homeoffice.gov.uk/publications/crime/cri minal-records-reviewphase1/http://www.homeoffice.gov.uk/publications/crim e/criminal-records-review-phase2/ and the IOCP website www.iocp.org.uk

ACUPUNCTURE COURSE ESPECIALLY FOR PODIATRISTS AND CHIROPODISTS The IoCP Faculty of Education (FofEd) is working to produce new courses aimed at developing further your clinical skills whilst increasing your earning potential.

Following the request from a member for a course on acupuncture the FofEd has produced a training course designed especially for Podiatrists/Chiropodists.

Working with recognised experts in this discipline a foundation course will begin running in March 2012. The course will be accredited by the University of Hertfordshire and those who wish to enrol with UH will be eligible for 30 APEL points on successful completion of the course. The tutor is Jennie Longbottom, MSc MMEd BSc FCSP MBAcC. Early booking is recommended as there are a limited number of places for the first course which should be booked direct with: http://www.alied.co.uk/ALIEDPro.html where you will also find more information about the tutor, dates and venue.

This course is open to all HPC registered Podiatrists/Chiropodists.

page | 21

OBITUARY

Henry Frederick Beaumont Hon.F.Inst.Ch.P I was very sad to hear about the death of Fred. He held the office of President from 1998 to 2001, after which he held the post of Press & Publicity officer until September 2011.

He had trained as a physiotherapist before becoming a chiropodist . He was generous in sharing his knowledge and I learned a great deal from him both during the lectures he ran at Sheffield Training Centre for the IoCP and on other occasions. An enquiring telephone call to him from me would be greeted with his softly spoken voice followed by some mischievous remark. He had suffered for many years with arthritis which prevented him from travelling to IoCP events but Fred managed to attend the 50th AGM where at our dinner/dance he took to the floor with his wife, Dorothy for a number of dances.

He was always a gentleman and my sincere sympathy are sent to Dorothy and his family.

Heather Bailey, President IOCP

I have known Freddie and Dorothy Beaumont for many many years. He was an Institute man through and through. His highlight in the Institute was when he was President - and he was a very good president. If you asked him a question you received a measured response. He would always tell you the truth.

I had reason to be grateful to Freddie when I was on the Joint Steering Group Committee dealing with the other two main chiropodial bodies before the formation of the Health Professions Council. I always appreciated his wise advice, support and friendship.

When Freddie retired from being President he took on the press and publicity committee, spending many hours on the phone dealing with journalists from the national newspapers and magazines getting the Institute’s viewpoint across. I know he was sad when eventually he had to give it up.

Freddie was a physiotherapist as well as a chiropodist so he 22 | page

also brought the physiotherapy view point to any clinical condition.

So goodbye old friend, I have many fond memories of you and Dorothy at the Cliffs Hotel, Blackpool, the St John’s Hotel Solihull and many other places besides. You were an Institute man and you never let us down.

Roger Henry, Editor, Podiatry Review

I would like to extend sincere condolences on behalf of myself and my wife to Dorothy Beaumont and family on the sad passing of Fred.

I had many years of working alongside Fred on the Executive Committee. Fred was always kind to me, but his greatest attribute was that he always had time to listen, encourage and advise. He had also been the Chairman of the Board of Ethics so he was always a source of profound wisdom to me.

He was a true and loyal friend to me and our association.

Goodnight and God bless Fred. I will miss you my friend.

Stephen Willey, Ex Chairman, Board of Ethics Sheffield Branch

I have known Fred for over thirty years and worked with him both as a tutor and on the executive which he served for many years. I almost succeeded him as the chair of the Board of Ethics (there was on other person between times). He was very skilled and knowledgeable in all that he did and a man of the utmost professionalism.

My condolences go to Dorothy and his family - may you rest in peace Fred.

Carl Burrows Ex Chairman, Board of Education

OBITUARY

Fred Beaumont was for many years the Press and Public Relations Officer for the Institute, he was enthusiastic and had his finger on the pulse on what was happening in the media and TV, especially when it came to items with regards to chiropody.

various offices in the Institute, including North East Area Council Delegate, Chairman of the Board of Ethics, Chairman of the Board of Education, culminating in being elected President. All these appointments and many more, he fulfilled with great dedication and knowledge.

On many occasion I helped Fred with any PPRO matters that may have involved London and the national newspapers. The only problem was that when Fred rang, it meant that within an hour I would have to appear on national television to discuss various topics of new trendy footwear or common foot disorders associated by to high a heel. Other times there were interviews on national radio, such as Womans Hour and even as a cameo chiropodist on the Archers again, at a moments notice!

He fully supported both Jim as Accountant/Secretary and subsequently myself as Secretary and was always available to answer questions or give advice.

Over the years Fred wrote articles for many journals, newspapers and magazines on our behalf and was always a source of information, he was very methodical and served the Institute well.

We shall miss him.

David Crew Surrey and Berkshire Branch

As echoed by everyone here and many others beside, I will miss Fred Beaumont’s advice and friendship very much. He helped me enormously over the years with queries from members and journalists alike, always ready to take even the most obscure phone calls at any time and help out wherever needed.

Fred loved our annual dinner dance and was always proud to wear his Scottish tartan. I know it saddened him that, due to health problems, he was unable to attend our last AGM at Windsor, particularly as it was held at Beaumont House!

My thoughts are with Dorothy and all the family at this sad time.

Night God Bless Bernie Hawthorn Editorial Assistant, Podiatry Review

Members will probably remember him for his excellent ballroom dancing at the AGM Dinner Dance, with his wife Dorothy.

We send our love and sympathy to Dorothy and his family.

Susan and Jim Kirkham

Birmingham Branch Fred Beaumont was such a genuine person and a true gentleman; he was a pleasure to know and serve with on the executive committee.

I have very fond memories of Fred, both in his role as senior tutor for the Institute where I was lucky enough to benefit from his knowledge and experience whilst doing my Modules 5 and 6 of the D.Ch.M. at U.M.I.S.T Manchester. He was a wonderful tutor and mentor. He was strict, he didn't tolerate any messing about, but fair with all his students.

I also had the privilege to work alongside Fred during his term of office as President of the Institute His wisdom, knowledge and advice especially during the H.P.C. formation made him a valued and trusted member of the team.

Later he became the Press and Public Relations Officer for the Institute where I am sure he will be sadly missed by Bernie and all the office staff.

On a lighter note I will always remember the striking figure Fred made at conference dressed in his beloved kilt where he and his lovely wife Dorothy took the lead round the dance floor showing us younger ones a thing or two!

Fred was a loyal and well respected stalwart of the Institute loved and missed by all who knew him.

Sincere condolences to his family.

It was with sadness that we learnt of the death of Fred Beaumont.

Christine Hughes Ex North West Area Council Delegate North West Branch

Fred was one of a number of exceptional people who comprised the Executive Committee of the Institute when Jim was first appointed its Accountant in 1972. He held page | 23

PRESS RELEASE

TalarMade announce the appointment of a new Managing Director TalarMade, a leading International supplier of foot orthoses and orthopaedic supports, are pleased to announce the appointment of Ian Leddy as Managing Director for UK based operations.

Ian has extensive senior management experience in the orthopaedic/ healthcare industry after many years as Commercial Manager with Trulife where he managed their Orthopaedic and Breast care Sales Teams. Ian says of his new role, ‘ TalarMade have achieved considerable growth and brand establishment over recent years . In particular they have built an enviable reputation for high quality innovative products coupled with first class customer services. ‘ Ian added, ‘ The past 12 months have seen Talarmade make significant investments in supply chain infrastructure, new product ranges and extensive marketing support. The launch of a new catalogue and fully integrated e-commerce website during 2012 will provide an excellent platform for

TalarMade to continue its growth and success. The opportunity is fantastic and I’m very excited to be leading the team in reaching this potential.’

Bernie Crewdson will remain in his position as Chairman and will continue with hands on management of TalarMade’s growing international market share. Bernie added ‘ 2011 has been a very successful year for TalarMade and despite the current economic climate we have seen double digit percentage sales growth. Ian has the perfect credentials to lead TalarMade in continuing this success in 2012 and beyond. I am very pleased he will be part of the TalarMade team and wish to congratulate him on his new position.’

For more information about TalarMade and TalarMade products contact: (01246) 268456, email info@talarmade.com or visit www.TalarMade.com

N E W P ro d u ct G u id e O rth o p a e d ic a n d Fo o tca re p ro d u cts

G re a t Q u a lity M o re C h o ice N e w In n o v a tio n Fa b u lo u s P rice s

O rd e r y o u r co p y T O D A Y C a ll: (0 1 2 4 6 ) 2 6 8 4 5 6 V is it: w w w .Ta la rM a d e .co m E m a il: in fo @ Ta la rM a d e .co m

24 | page

INFORMATION

The unstoppable rise of the ladies’ shoe size Hands up who’s ever almost been reduced to tears in a shoe shop when, after a thorough search, you work out that the largest size they stock is a six? ‘I won’t come back here,’ you think, humiliated and shod in a pair of gentlemen’s brogues. ‘My big old size nines are destined to spend their lives in mens’ shoes.’ Fear not, ladies. For those of us that have larger feet, things are about to change.

Jane Winkworth, the founder of shoe company French Sole, has recently acknowledged that ladies’ feet are getting bigger.

“When I started designing, the standard size was a five,” she said recently in an interview. “Now, girls of 16 or 17 are taking a sevenand-a-half or an eight. Each generation has bigger feet, and it’s because they are better fed and everybody does a lot more exercise.

Monica Lott, who runs Norwich-based online shoe retailer FYFO alongside husband Martin, has noticed the increase in demand for larger shoes for ladies. “It’s very hard to ignore,” she says. “We receive a lot of interest in our shoes, which is marvellous, but it’s very disheartening when we have to tell customers that we only sell up to a size eight for ladies shoes.

We’ll be looking at getting larger sizes in stock in the near future; why should women with larger feet be left out? You can’t expect ladies to wear mens’ shoes – and high heels aren’t just for smaller feet.”

I always end up buying heels a size too small and kidding myself that it’ll be OK, but after a night of agony I fling them off and never wear them again.”

Fellow size 8 devotee Lauren Cook has also had her fair share of foot issues, due to having large feet. “When I was younger, being a size eight used to be a problem, as not a lot of stores stocked ladies shoes in that size. However, I have noticed that within the last 10 years or so, size eights have been far more readily available,” she says. “I don’t know if this is because the demand for them has increased, or if they have started listening to the complaints of the larger-footed lady. I’ve also noticed that the cheaper the shoe shop, the less likely you are to find bigger sizes.”

French Sole’s Jane Winkworth should perhaps have the last word, as this foot phenomenon shows no signs of stopping - or slowing down. “In the 23 years I have been producing shoes, I’ve noticed that the average shoe size of women has increased from a 38/39 to a 40/41, which is reflected in the stock we are ordering for our stores and mail order,” she says. “I saw a huge gap in the market and a demand for larger sizes for women up to a 44, which many retailers simply do not cater for at the moment.”

For more information go to www.fyfo.co.uk

W J Liggins, the Chairman for the Institute of Chiropodists and Podiatrists, has noticed that womens’ feet sizes are increasing but that larger shoe sizes are relative to height. “Although feet are getting bigger, they remain proportional to the individual,” he explains. “It is generally held that the proportions are roughly 15.5% of height for males and 14.5% for females. In other words, the population in developed countries is becoming generally larger - and feet are getting larger as a result.”

Reporter Lucy Wright wavers between being a seven and an eight, and rues shoe shops’ lack of choice. “It's difficult to find shoes which are nice, as many brands stock go up to a size seven and even when the shop or brand does sell larger sizes, they are usually out of stock,” she says. “I have never bought shoes in a smaller size to squeeze my feel into - I am on my feet a lot during the day so what I wear has to be comfortable. I own about 50 pairs of shoes and although I own heels, I pay for it the next day if I wear them on a night out. Being 5'10’’, I tend to wear flats anyway.”

So, this seems to be a problem that’s got natural causes. Due to a better diet and more exercise, we’re getting bigger - and as a result, our feet have followed suit. But how have other women taking a size eight shoe negotiated the stormy waters of shoebuying?

“I’ve always found it difficult to find shoes that fit me properly,” says Francesca Woollon, who takes a size eight shoe. “So many shops don’t make decent footwear if you’re over a size six; it’s so frustrating. They make heels that look lovely in a size five, but like canoes when they get up to a size eight. I can’t ever find any high heels that don’t rub me, or cause me pain by the end of the night. page | 25

AGM BOOKING FORM Name: ..................................................................................................................................................................................................

Address:................................................................................................................................................................................................. ........................................................................Postcode………………………….……….Telephone Number................................................

MEMBER OF WHICH PROFESSIONAL BODY…………………………………….

Friday, 27th April 2012 £20 PER LECTURE 2.00pm Lecture Current Issues in Palliative Care (Main conference area) 6.00pm Lecture Current Concepts in Hip and Knee Replacement Therapy (Main conference area) Includes admission to the Trade Exhibition

£20 £20

G G

Saturday, 28th April 2012 £70 ALL INCLUSIVE (Please tick your choice of lectures and workshops) G £…………….

Day Delegate Rate- possible choice of 4 lectures/workshops including lunch in Ramada Plaza Hotel and refreshments in the Trade Show - £70 (saving over £20.00) Includes admission to the Trade Exhibition

9.30am Workshop Padding & Strapping (Syndicate room)

G

11.30am Workshop Diabetic Assessments, How to carry them out in your practice (Syndicate room) G

1.30pm Gallagher Heath – Insurance Presentation and Q & A’s (main conference area) 2.30pm Lecture Lower Limb Lymphodema, Causes, Diagnosis and Treatment (MLD) Rebecka Blenntoft (main conference area) 2.30pm Workshop Demonstration on the practical application of nail surgery (Syndicate room) 4.00pm Lecture Pharmacology for the Podiatrist – Matthew Rothwell (main conference area) 4.00pm Workshop Cautery of troublesome skin lesions and verrucae using Hyfrecators (Syndicate room)

G G G G

7.00pm President’s Reception for guests attending the Dinner Dance and includes a complimentary glass of Wine/Orange juice 7.30pm until midnight Dinner Dance and Awards Ceremony Dinner Dance Tickets @ £35 per person x……………… people

G £…………….

NAMES ATTENDING DINNER DANCE………………………………………………………………………………………………………………………………………………...…….

Names of persons with whom you would like to be seated at the Dinner Dance (Saturday) – ............................................................................................................................................................................

Whilst we will endeavour to meet your request, we cannot guarantee this Special Requirements Vegetarian G Vegan G Other Requests/Dietary needs…………………………………………………………………………………………………… TOTAL

==================

To book accommodation please see https://www.conferencebookings.co.uk/delegate/STH2012IOCP Payment 1. Credit Card - Credit card charge of 2% applies and Debit Card charge of 50p applies  ÆÄ ÀĆĄĀĈ Č ÂǼBĀÆ Â ÆÄ Č ÁÅǼÂ Č ÂĀǼBÆǺ Č AC ÅBÃĂ Card Number: ....................................................................................... House Number: …………… Postcode.......................

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2. Cheque I enclose a cheque for £.............................. made payable to “The Institute of Chiropodists and Podiatrists” Please return your completed form with payment to: The Institute of Chiropodists & Podiatrists, 27 Wright Street, Southport, Merseyside, PR9 0TL Telephone number 01704 546141 TERMS AND CONDITIONS If a booking is cancelled and no replacement participant can be found, the following cancellation charges will be incurred: · Cancellation 31 days or more before the event takes place: no charge ·

Cancellation between 14 days and 31 days before the event takes place: 50% of total price

·

Cancellation less than 14 days before the event takes place: 100% of total price

·

The Institute of Chiropodists and Podiatrists reserves the right to cancel or reschedule seminar location or times, or to arrange a substitute lecture if this is absolutely necessary and out of our control. In these cases The Institute of Chiropodists and Podiatrists are not required to compensate travel or accommodation costs, loss of working time or other damages.

Rates include VAT @ current rate

VAT No 712 5290 59

BRANCH NEWS

West of Scotland Branch In 1997, I attended my first branch meeting as a rookie.

Believe it or not I was nervous and very unsure of what I was going to encounter and what the procedure was. It soon became apparent that this was not quite a normal meeting, it was in fact the inaugural meeting of the West of Scotland branch after the amalgamation with the Association.

I needn’t have worried at all, because my first greeting and meeting was with Ann York who I thought at that time unbelievably welcoming, however I quickly learnt - I wasn’t singled out for special treatment - this is her style; putting everyone at ease.

When I joined at the inaugural meeting Ann was being voted into the chair and this was a position she held for many years, steering the branch through various ups and downs. One of her many highlights was when she co‐hosted the first National Conference and A.G.M. to be held in Scotland. This was such a success! The re‐configured formula has been continued throughout successive years!

She has represented Scotland on the National Executive for some considerable time and has never shied away from the hard work created; whether that be from being on the Board of Education; proof reading the Review or the very onerous task of being on the Board of Ethics.

Ann has a natural knack for calming any situation. Since I’ve been on the executive, I’ve seen first‐hand that this does not stop at branch and area level, it also goes through to national level where, as you can well imagine, things do sometimes get a

little fraught to say the least! Ann was always there with a kind word or a gentle hand to sooth the troubled waters and to utter words of common sense, she is someone who I have never in all the years I’ve know her raised her voice, lost her temper or her cool, she is the perfect Lady and the perfect representative in every way and will be sorely missed.

She is my mentor and my friend.

Ann, please accept this small token of our thanks and gratitude from your colleagues and friends.

Jacquie Drane West of Scotland Branch

H ello M em bers .

A little w h ile ago yo u w ere s ent details o f a new c o u rs e being o ffered to H P C m em bers . A w ell es tablis h ed c o u rs e h as been adapted fo r P o diatris ts to s tu dy ac u pu nc tu re as an extra m o dality in yo u r prac tic e. I t is linked w ith th e U nivers ity o f H ertfo rds h ire fo r w h ic h po ints to w ards a M as ters c an be gained.

H o w ever, th o se w h o h ave no t go ne do w n th e degree ro u te need no t be c o nc erned th at a degree is nec es s ary and a prerequ is ite to go o n th e c o u rs e. I am o n th e c o u rs e at th e m o m ent w h ic h h as been des igned o riginally fo r ph ys io th erapis ts and alth o u gh it is s tretc h ing ac adem ic ally, Jennie' s teac h ing s tyle h as no t pu t m e at a dis advantage. Yo u h ave pro bably gu es s ed I do no t h o ld a degree.I w ill no t u ndertaking a M asters .

T o u nders tand th e c o nc epts o f ac u pu nc tu re bas ed o n traditio nal c h ines e m edic ine as w ell as w es tern m edic ine,a bas ic kno w ledge o f th e w h o le bo dy is h elpfu l. W o rking w ith ph ys io s o ver th e las t few w eeks o n th is c o u rs e, I h ave h ad to c o m e u p to s peed very qu ic kly!!. H o w ever, rath er th an ju s t a w h o le bo dy o verview , th e po diatric c entred c o u rs e w ill apply th e c o nc epts to lo w er bo dy in m o re detail. Yo u w ill be expec ted to do a s h o rt pres entatio n and a c as e s tu dy to s h o w th at yo u h ave fu lly u nders to o d th e princ iples and to ens u re th at yo u c an prac tic e s afely.

A lth o u gh I am part w ay th ro u gh , and h ave been c h allenged I am th o ro u gh ly enjo ying th e c o u rs e.

M y initial fears abo u t th e s tandard expec ted h ave been allayed. I did no t feel th at I c o u ld rec o m m end a c o u rs e if I h ad no t u ndergo ne it. I h ave alw ays lo o ked fo r o ppo rtu nities fo r C P D and w ays to enric h m y w o rking life and to be able to o ffer th e bes t available treatm ent to m y patients and to s h are th is w ith c o lleagu es . T h is c o u rs e h as c ertainly lived u p to m y expec tatio ns and I am h appy to rec o m m end it.

Angela Foster East Anglia Branch 28 | page

BRANCH NEWS

North West Area Council Sunday 16th October saw the gathering of the North West Area Council for their 14th annual seminar held at Preston University. The event was well attended, not only by the Institute members, but also by suppliers; Chiropody Express, DLT, Cuxson Gerrard, Canonbury, La Corium Health, Algeos, Hillary Supplies and Accrington Surgical Limited.

The lectures on heart disease, Parkinson’s disease and peripheral vascular disease were thoroughly enjoyed. Members felt that these diverse lectures provided invaluable knowledge to help improve care delivered for clients whilst aiding CPD. It was also our privilege to host the Institute’s president, Heather Bailey and vice-chairman, Malcolm Holmes. The event, whilst educational, was also a social success helped by an excellent lunch with plenty of tea and coffee. A raffle held raised £93 donated to our benevolent fund. Prizes were kindly donated, not only by members, but also by Alan Fletcher from Chiropody Express.

naturally painless!

Painless treatment Contains natural ingredients Suitable for children over 3 years Effective against all type’s of warts and verrucas Direct effect that penetrates deeply Puts a protective layer over the wart Simple to apply

These events would not be possible without the hard work of many. We would like to thank Denise Willis, Linda Pearson, Michelle Taylor, Barry Carter, David Topping and Brian Massey for their efforts into making this conference such a success.

Michele Allison, Chairwoman, North West Area Council Call 01274 885523 for all your sundries & equipment chiropody@trycare.co.uk www.trycare.co.uk Trycare, Westpark, Brackenbeck Road, Bradford, BD7 2LW

page | 29

RAMBLING ROADS

When is callous pathological and when is it physiological?

The last entry on this thread on Podiatry Arena web site was on 1st February. Basically, it seems that no-one truly agrees although Belinda Longhurst described the histological changes as a proliferation of fibroblasts, disorganisation of the rete pegs and thickening of the stratum spinosum. Does that mean that all callous is pathological? The general consensus seems to agree that these changes only take place as a result of skin stress and that per se results in pathological changes; therefore callous should always be debrided. Another view states that the resulting thickening of the epidermis is protective and should therefore be left alone, as aggressive debridement will give rise to pain and further thickening of the skin. The final consensus seems to be that pathological presentations should be treated. Thus callous should be debrided but the predisposing factor identified and treated in an attempt to prevent, or at least reduce the occurrence. Further postings are awaited with interest.

New Scientist of 14th January brings news of a breakthrough in eye examination. The cone cells in the retina which allow us to view colours carry membranous discs which are shed as they grow older and are replaced by new discs. Ravi Jonnal and colleagues at Indiana University have measured growth by reflecting laser light off the cells and reflecting another part of the beam from a mirror. When the two beams recombine the pattern of interference allows the researchers to track each single disc and showing that the cells grow at circa 150 nanometres per hour. Fred Fitzke of University College London, stated “This could lead to major advances in preventing the progress of some of the leading causes of blindness”.

The December 2011 Journal of the Royal Society of Medicine Vol. 104 no.12, has two interesting and relevant articles. The first, by Metcalfe D. and Powell J. asks ‘Should Doctors spurn Wikipedia’. It is worth noting from the outset that students of the Institute of Chiropodists and Podiatrists are not discouraged from using this on on-line resource but are encouraged to track down the references in Wikipedia to source. The problem is that anyone can edit an entry, and it has been noted that certain providers of courses and orthoses have edited relevant entries to favour their particular device or interpretation of pathological foot presentation. Overall, however, the article is favourable and states that 17% of contributors to ‘Nature’ used 30 | page

Wikipedia, which indicates that a substantial number of scientists visit the resource; additionally, it is within the top ten of search results for medical terms. If professional practitioners were to withdraw from the site, then the aforesaid vested interests and their fellow-travellers promoting themselves and their products would remain.

The article ends by suggesting that Wikipedia offers a quick search resource for educational matters and as such is a useful instrument for preliminary literature searching.

However, it should be used with caution and the material therein checked with other sources. Happily, this coincides with the view of the Institute’s academics.

The second article by Dickerson K. and Chalmers I. deals with incomplete and biased reporting of clinical research.

Francis Bacon (the father of science) stated in the 1600s that “The human intellect is more moved by affirmatives than negatives” whilst Austin Badford Hill (the father of medical statistics) wrote in 1959 that “A negative result may be dull but often it is no less important than the positive; and in view of that importance it must, surely, be established by adequate publication of the evidence.” In the latter half of the 20th century, investigations showed that research yielding negative results was disproportionately less likely to be published than those demonstrating positive findings. Negative findings also took longer to appear in print than positive findings. Following the scandal of the suppression of evidence of the potential serious side effects of the drug paroxetine in 2004, the International Committee of Medical Journal Editors announced that in order to be published, future studies would require to be registered before the enrolment of participants. As more and more members of the Institute become involved in research, this will also be an expectation of this journal.

Sad news for wine lovers! The 21st of January volume of New Scientists reports that some of the research claiming that wine is good for health was faked. A three year investigation by the University of Connecticut concluded that Dipak Das, head of its cardiovascular research centre was guilty of 145 counts of fabrication and falsification of data. Much of the work suggested that resveratrol, a compound found in red wine, had health benefits.

However, other researchers have also reported beneficial effects of the compound.

Achilles Hele

DIABETES NEWS

Diet rich in flavonoids could provide health benefits for people with Type 2 diabetes A diet rich in foods containing powerful antioxidants called flavonoids may not only lower the risk of heart disease in women with Type 2 diabetes but also reduce their cholesterol and help manage diabetes, suggests a new study by the University of East Anglia.

Published today in the journal Diabetes Care, the Diabetes UK funded 12‐month trial provides further evidence that diet offers extra protection in people at high risk of cardiovascular complications.

Reduced risk of heart attack Ninety-three postmenopausal women with Type 2 diabetes took part in the trial. Half were given two small bars of flavonoid‐ enriched chocolate each day, and half were given placebo chocolate bars. Those receiving the extra flavonoids reduced their risk of suffering a heart attack in the next decade by 3.4 per cent.

Their insulin resistance and cholesterol levels were also significantly reduced.

Commercial chocolate of little benefit However, the researchers emphasise that the results do not mean that people with Type 2 diabetes should eat more chocolate. This is because commercially available chocolate contains much less of the beneficial flavonoids than the chocolate consumed in the trial, and eating too much chocolate may cause weight gain.

Flavonoids protect the cells in your body from damage by free radicals, which are molecules produced by pollution and the body’s normal metabolic processes, and which are responsible for causing ageing, tissue damage and possibly some diseases.

Foods such as onions, apples, berries, kale and broccoli contain the highest concentrations of flavonoids; high amounts are also found in tea, dark chocolate and even red wine. The chocolate bars used in the trial were specially created with the help of a Belgian chocolatier to provide a high dose of two types of flavonoids.

Postmenopausal women with diabetes were chosen for the study because, despite being on established statin therapy, they are at high risk of heart disease. Deaths due to heart disease increase rapidly after menopause, and having Type 2 diabetes increases this risk by a further three-and-a-half times.

Better protection than conventional drugs?

Dr Iain Frame, director of research at Diabetes UK, said, “Although this trial involved quite a small number of women already at high risk of heart disease, these compounds appeared to offer them better protection against heart problems than conventional drugs when administered under very carefully controlled circumstances.

“Flavonoids are found in tea, red wine and other foods, but this study only looked at the effects of specially prepared

chocolate with much higher amounts of flavonoids than in chocolate available commercially. We would be very concerned if the results of this research were reported as encouraging people with Type 2 diabetes to increase their consumption of chocolate and red wine. Both of these can cause weight gain that would eliminate the health benefits described here and should only be consumed as part of a healthy balanced diet. It will be interesting to see whether larger studies of different flavonoids in more diverse populations over longer periods demonstrate similar effects.”

Previous studies have shown that dietary flavonoids reduce the risk factors for heart disease in healthy people. However, this is the first long‐term study to examine their effect on a medicated, high-risk group.

Nice approves weekly treatment for Type 2 diabetes The National Institute for Health and Clinical Excellence (NICE) has issued its final draft guidance on the use of Bydureon (exenatide) as a treatment option for some people with Type 2 diabetes.

Exenatide is already in use as a twice daily injection known as Byetta, but Bydureon only needs injecting once a week.

Although exenatide is injected, it is not insulin and works in three ways: to help the body to produce more insulin when it is needed; reduce the amount of glucose being produced by the liver when it is not needed; and by reducing the rate at which glucose from food is released into the blood.

The NICE guidance recommends the treatment be used in conjunction with other diabetes treatments – metformin and a sulphonylurea, or metformin and a thiazolidinedione.

Exenatide is recommended for people with Type 2 diabetes whose blood glucose levels are not well controlled and have other risk factors, including a body mass index (BMI) of 35 or above. It can be used in patients with a BMI below 35 if treatment with insulin has presented problems. NICE recommends the treatment should only be continued if tests show it is having a beneficial effect after six months.

Simon O’Neill, Director of Care Information & Advocacy at Diabetes UK, said, “We welcome this guidance because we strongly feel that a weekly injectable exenatide will widen the treatment options for people with Type 2 diabetes who may be struggling to achieve good diabetes control. For people who are currently using exenatide and injecting it twice a day, the possibility of instead doing it once a week could really improve their quality of life.”

NICE has not yet issued final guidance to the NHS. It is likely to publish the final guidance in February 2012. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments. Once NICE issues its guidance on a technology it replaces local recommendations in England and Wales. page | 31

The Institute of Chiropodists and Podiatrists

SOUTHERN AREA COUNCIL Spring 2012 Seminar Saturday 24th March 2012 at

Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex The Programme: 9.00 am 10.00 am 10.05 am 11.05 am 11.30 am 12.30pm 1.30 pm 2.30 pm 2.45 pm 4.00 pm

Registration, Tea/ Coffee/ Trade Fair Welcome and Introduction Dr. Andrew McVicar BSc, PhD, FHEA: Lecture on the Control of Posture and Movement Break / Trade Fair Dr. Rajshree Mootanah PhD: Lecture on Gait Analysis Research Lunch on the mezzanine/ Trade Fair Trevor Money BSc (Hons), PGDip, HPC reg: Practical Workshop on Emergency Airway Management Break /Trade Fair Carol Ellis BSc (Hons), PGDip, FHEA, SBRCP and Beverley Wright BSc (Hons), PGDip, FHEA, SBRCP, HPC reg: Practical Workshop on Reflexology & Relaxation Techniques Raffle, CPD Certificates and Close of Seminar

Delegate Information The SAC Seminar includes: • Speaker Presentations • Workshops in the afternoon – Seminar delegates will have an opportunity to attend all the workshops • Opportunity to network with like minded professionals – the Seminar is open to all Health Professionals and Chiropodists & Podiatrists from all organisations • Market Place – Trade and information exhibitors • Lunch, refreshments and free parking • Easy to get to by bus, car or train (directions available) • CPD Certificate • Cost: £60.00 The Southern Area Council reserves the right to cancel, reschedule or substitute any lecture or workshop as part of the SAC Seminar programme at short notice, if absolutely necessary, or for reasons beyond our control.

Closing date for bookings: 19th March, 2012 Please complete the booking form and return, enclosing a cheque for £60.00 made payable to the IOCP Southern Area Council to: Mrs. Flavia Tenywa (SAC Hon. Treasurer), 96b High Street South, East Ham, E6 3RL. For further information: Tel: 0208 586 9542, Mobile: 07956 980815 or E-mail: fixmytoe@aol.com !

!

SAC Spring Seminar 2012 Name: .....................................................................................

Branch: ......................................................................................

Address: ......................................................................................................................................................................................... ..................................................................................................................................

Tel No: .....................................................................................

Postal Code:.............................................

Email: ........................................................................................

Dietary Requirements: ...................................................................................................................................................................

Signature: .................................................................................................................

32 | page

Date: ........................................................

CLASSIFIED

r ooms v acant a r Le Ne Mi t CHe LL Ha i r & Be a Ut Y Arlene currently has a room vacant which would suit a self employed Chiropodist/podiatrist in a very busy salon, in Kilmacolm, Scotland. This would be an excellent opportunity for someone. If anyone is interested call Arlene on 07949615571 or 01505871280.

Chiropody s upplies

Chiromart UK ‘WHY Pa Y Mo r e ?’

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)

Practices f or s ale t o r q Ua Y, d e v o N r e t i r e Me Nt s a Le Surgery/D.V. Est 25 years Income £17K over 3 days Scope for Expansion - £17K Tel: 01803 211616 Wa t f o r d , He r t f o r d s Hi r e .

An opportunity arises due to retirement, for an approved practitioner to continue a long established and profitable surgery. Ground floor shop premises with seven day access and low inclusive rent. Proper introduction and handover will be given to my patients with after support if required. Available free of charge although a reasonable contribution for the modern equipment, if wanted will be required. Profit from day one.

Write in first instance with your identity and contact details to Box No 1201 Podiatry Review, 27 Wright Street, Southport, PR9 0TL s o Ut H Li NCo LNs Hi r e Three bedroom detached house with integral surgery for sale - London 55 Minutes by rail.

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.

AMBER CHIROPODY SUPPLIES Serving the chiropodist/podiatrist with all the essential daily consumable items for a busy practice, including: * In s tru m e n ts & E q u ip m e n t * D o m ic ilia ry * P a d d in g & A p p lia n c e s * S te riliz a tio n * D re s s in g s & A d h e s iv e s * D ia g n o s tic s * B io m e c h a n ic s * R e ta il P ro d u c ts To view our website/online store please visit:

w w w .a m b e rs u p p lie s .c o .u k page | 33

DIARY

34 | page

DIARY

page | 35

NATIONAL OFFICERS

National Officers

National Officers Area Council Executive Delegates

Branch Secretaries

Branch Secretaries

Area Council Executive Delegates

36 | page

Our Brand New Website is up and running!

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