Podiatry Review November/December 2014

45770 PodiatryRev Nov-Dec 09/10/2014 11:30 Page A

ISSN 1756-3291

Volume 71 No. 6 November/December 2014

Podiatry Review A step in the right direction

I n s i d e : ◆ B o t u l i n u m To x i n ◆ M o i s t u r i s i n g s k i n ◆ L e s t w e f o r g e t ◆ D e r m a t o p h y t e

The Institute of Chiropodists and Podiatrists “Supporting the Private Practitioner”

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National Officers President Mrs L. Pearson MInstChP BSc Pod Med

Acting Chairman Board of Education Miss Joanne Casey MInstChP BSc

Chairman Executive Committee Mrs C. Johnston MInstChP BSc (Hons)

Honorary Treasurer Mrs J. Drane MInstChP

Vice-Chairman Executive Committee Mr A. Reid MInstChP

Standing Orders Committee Mr M. Hogarth MInstChP

Chairman Board of Ethics Mrs J. Dillon MInstChP

Secretary Miss A. J. Burnett-Hurst Hon FInstChP

Area Council Executive Delegates Midland Area Council Mr S. Miah BSc (Pod M) MInstChP

Scottish Area Council Mrs H. Jephcote MInstChP

North West Area Council Mrs M. Allison MInstChP

Southern Area Council Mr D. Crew OStJ FInstChP DChM CertEd

Republic of Ireland Area Council Mrs C Tindall MInstChP BSc (PodMed) LCh

Yorkshire Area Council Mr N. Hodge MInstChP

Branch Secretaries Birmingham

Mrs J. Cowley

01905 454116

Nottingham

Mrs V. Dunsworth

0115 931 3492

Cheshire North Wales

Mrs D. Willis

0151 327 6113

Republic of Ireland

Mrs C. O’Leary

Devon & Cornwall

Mr M. Smith

01803 520788

Sheffield

Mrs Z. Slade

Essex

Mrs B. Wright

01702460890

South Wales & Monmouth Mrs E. Danahar

01656 740772

Hants and Dorset

Mrs J. Doble

01202 425568

Surrey and Berkshire

Mrs J Hornby

01252 514273

Leeds/Bradford

Mrs M. Ward

01423 819547

Sussex

Mrs V. Probert-Broster 01273 890570

Leicester & Northants

Mrs S. J. Foster

07845 949811

Teesside

Mr J. Ollivier

01287 639042

London

Mr W. G. Loader

07956 962744

Western

Mrs L. Pearson

01745 331827

North East

Mr A. Thurkettle

0191 454 2374

West Middlesex

Mrs H. Tyrrell

0208 903 6544

North of Scotland

Mrs S. Gray

01382 532247

West of Scotland

Mr S. Gourlay

0141 632 3283

North West

Mr B. Carter

01257 411272

Wolverhampton

Mr D. Collett

0121 378 2888

Northern Ireland Central

Mrs P. McDonnell

028 9062 7414

00353 295 1938 01246 477725

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November/December 2014 | Volume 71 No. 6 ISSN 1756-3291

Podiatry Review

Published by

Contents

The Institute of Chiropodists and Podiatrists 150 Lord Street, Southport, Merseyside, PR9 0NP Tel: 01704 546141 Email bernie@iocp.org.uk Web: www.iocp.org.uk

Editorial ..................................................................2 Dermatophyte.........................................................5 Nigel Jones-Blackett, Metachem Ltd Botulim Toxin – Part 2.............................................8 Martin Harvey PGCert BSc MCPodSurg MInstChP

Editor Mrs B Hawthorn HMInstChP

What makes a good skin moisturiser ....................12 Alan Posthlethwaite, Hilary Supplies

Academic Review Team

Osteoarthritis: Could stem cell therapies be the answer.......................................................14 Arthritis Research UK

Mrs J Barbaro-Brown MSc PGDip PGCE BSc (Hons) BA (Hons) DPodM MChS HonFInstChP

Ms B Wright

Prescription Pad ...................................................18 Martin Harvey PGCert BSc MCPodSurg MInstChP

MSc BSc (Hons) PGCE PGDip MInstChP

Mr S Miah

The Pen is Mightier ...............................................20 Diabetes UK

BSc(PodM) MInstChP

Miss J Casey BSc (Pod) MInstChP

Obituaries – John Patterson .................................22 Branch News........................................................29 Classified Adverts .................................................31 AGM Booking Form..............................................33 Diary of Events .....................................................34

http://twitter.com/iocp_chiropody Lest We Forget .....................................................36 The Institute of Chiropodists and Podiatrists-Southport

© The Institute of Chiropodists and Podiatrists Disclaimer: 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.

Published by Mitchell & Wright Printers Ltd, The Print Works, Banastre Road, Southport, PR8 5AL 01704 535529

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Annual Subscription £30 UK/£45 Overseas

Podiatry Review Vol 71:6

CONTENTS

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Editorial Dear Readers In the last issue I commenced by informing you I was writing the editorial in glorious sunshine and that it was hard to believe we were heading into autumn. Would you believe I am still writing in glorious sunshine and we are heading towards winter?!

This is our final edition for 2014. I do hope it has been a good year for the majority of you. It was with great sadness that we received the news that our former colleague and friend, John Patterson, had died suddenly (please see the many obituaries starting on page 20). We have also been informed that a long standing Honorary Fellow, Eileen Jeffrey has recently passed away.

Unfortunately, only David Crew and Carl Burrows of our current members knew Eileen and her husband George.

David Crew (Surrey and Berkshire Branch) writes: “I was sorry to hear of the death of Eileen Jeffery. George and Eileen were staunch members of the Institute. George had been Honorary Treasurer for several years and between them and the Birmingham branch had, on many occasions, organised the AGM of the Institute in Solihull, West Midlands”.

Carl Burrows (Birmingham Branch) writes: “I knew Eileen quite well, way back in the days when her husband George was our Hon. National Treasurer and they were both very active members of what was then just titled the Birmingham Branch. Both were at one time awarded Honorary Fellowship of The Institute for many services rendered. I have particularly fond memories of Eileen’s kind hospitality when we sometimes finished up at their house after various meetings and on other occasions. I am

sure many of our older members like me can remember them both. Rest in peace Eileen” Our condolences and thoughts are sent to both families.

As promised we have part-two of “A different wrinkle - on Botulinum Toxin Development of medical uses and method of action” from author Martin Harvey. In this sequel Martin describes how medical and cosmetic use of BTX-A (botulinum toxin type A) escalated and the conditions that fall within the purview of a podiatrist for which products containing BTX-A may be used. A fascinating read!

Martin has also kindly provided us with some notes from the prescription pad! A very useful article to aid your CPD profiles. Take a look on pages 18 and 19. Please note that Martin is an independent prescriber and is registered as a stakeholder representative for the podiatry profession. He will be liaising with the National Institute of Health and Care Excellence (NICE) on your behalf and will be happy to answer any questions on prescribing.

You may contact Martin either directly on bhapodiatric@btconnect.com or via Head Office.

As the subject of diabetes is prevalent in our line of work we have included an article written

by Sheila Reith and would like to thank Diabetes UK and Diabetes Balance magazine.

Sheila is a doctor but has first-hand experience as a mother of a child with diabetes. She explains how she revolutionarily changed the face of insulin therapy for ever and the

Dear colleagues,

It was really nice to hear from a few members regarding the trip to Germany next year. While you have your passport to hand, a feature by member Nicole Nanton in the October/November Review has requested help, so if any Chiropodists/Podiatrists would like to volunteer their help in Trinidad, perhaps we could arrange to go over in small batches throughout the year. We are trying to raise funds to help with transport and accommodation .

With all the Branch AGM’s looming in January a good way of earning CPD is to take up a role in your local branch, all you have to do is inform your Branch Secretary that you would like to help in a branch role and I’m sure they will be happy to advise you of the roles available. I encourage you to support your branch as a lot of hard work goes on to organise speakers, etc and its also social, you can exchange ideas with colleagues/friends and have YOUR say in planning events for the forthcoming year. Whether you are working at branch level, area council or national level we are all there to help and support each other and we can keep the organisation strong with good solid foundations.

Next year we have a few new courses coming up at HQ in Southport including: theraputic ultasound for lower limb and dry needling, following the success of the recent foot moblilisation course.

EDITORIAL

challenges she faced from design problems, opposition from Health bodies and manufacturers reluctance to get involved. Read Sheila’s story on pages 20 and 21.

Many of you will have met Nigel JonesBlackett at our Conference this year demonstrating Metachem Diagnostics Ltd’s In TrayTM – a simple but effective way of identifying Dermatophytes; the common fungi that cause a lot of common skin, nail and hair infections both in humans an in animals. Nigel has very kindly produced an article for Podiatry Review with graphic details of how the InTrayTM works.

If you would like more information please do not hesitate to contact Metachem (details are at the end of the chart on page 7) Alternatively come along to our 2015 conference on May 29th and 30th where Nigel will once again be demonstrating and answering your questions and hopefully dancing the night away on the Friday evening!

Well done Nigel, you are a force to be reckoned with on the dance floor. Our booking form is on page 33. As well as Nigel’s dancing we have a whole programme of events with many traders with offers and a chance to win a years free membership of the Institute! Everyone attending will be eligible to enter free of charge.

Details to follow.

In addition to the above mentioned we have lots of little news bits and branch information for you. I hope you enjoy reading and we will see you again in the New Year.

Bernadette Hawthorn, Editor

Have you signed up for an “enhanced listing” on the IOCP website? This enables a practitioner to inform the public of their practice, including any special skills without having to purchase their own expensive website.

We are looking for articles CPD and general to go into the review, if you could forward those directly to Bernie.

Looking forward to seeing you all at the 2015 AGM in Southport to celebrate the IOCP’s 60th Anniversary together.

Hope you all have a very Merry Christmas and a Happy New Year, or Naddolig Llawen, Blyddwyn Newydd Dda as we say in Wales!

Kind regards,

Linda Pearson President

Podiatry Review Vol 71:6

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IINNOVATIVE, NNOVATIVE,, UNBREAKABLE UNBREAKABLE &E EASY ASY TTO O US USE E Range ange o off a applications: pplicatiions: •C Correct problems orrect postural postural p roblems •A Adapt and monitor dapt prostheses prostheses a nd m onitor tthe he rrehabilitation re ehabilitation of of e equipped quipped p patients atients •H Help elp p prevent revent tthe he rrisk riisk o off d diabetic ulcers. iabetic u lcers.

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Jacquie Drane

Dear Practitioner,

Finding it hard to get time out of practice or funding to train?

Treating patients with numerous types of long-term conditions?

We can help. Diabetes in Healthcare is a simple solution to cover introductory diabetes training. Developed in partnership with Bupa, our free e-learning programme is aimed at healthcare professionals who are not diabetes specialists. And it is accredited by the Royal College of Nursing.

96% of Diabetes in Healthcare users who responded to our survey would recommend it to a colleague, and 80% now feel more confident in supporting people with diabetes.

We’d love you to take a look at www.diabetesinhealthcare.co.uk. Sign up and encourage your colleagues to do the same.

Diabetes in Healthcare was written by Diabetes UK’s expert team of clinicians and diabetes specialists and includes information on: • how diabetes is diagnosed, treated and monitored • how to care effectively for patients with diabetes • the risk factors, symptoms and potential health complications associated with diabetes • how to recognise patients at risk of health complications associated with their diabetes and how to support them to reduce their risk of developing those complications.

The programme is accredited by the Royal College of Nursing, so you can attribute everything you learn towards your ongoing professional development. The whole course can be completed in 2.5 hours, or individual modules can be done in just 25 minutes, enabling you to fit learning around a busy day.

We hope you find this resource useful, and that you’ll encourage your colleagues to sign up too.

Best wishes Cheryl Lenny Healthcare Professional Engagement Officer – Diabetes UK

DIABETES NEWS

Podiatry Review Vol 71:6

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Early

Mature

Microscope Morphology – Septate hyphae.

Macroconidia abundant, rare or absent.

However they can be long, narrow, thinwalled, parallel sides with 2 to 8 cells. They may form on the ends singly or in groups.

Microconidia (2-3 by 3-5 mm) lateral, teardrop shaped form on macroconidia.

Growth can start as early as 3 days. Matures in 14 days.

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Osteoarthritis: could stem cell therapies be the answer?

An exciting new trial to test the effectiveness of stem cells in early knee osteoarthritis is now under way. Jane Tadman reports.

Stem cells have long been heralded as the possible answer to a number of medical conditions, including osteoarthritis. And now a clinical trial testing the effectiveness of stem cells compared with cartilage cells in treating early osteoarthritis of the knee could point the way forward.

Funded by Arthritis Research UK, it is the first clinical trial in the UK to compare different cell types in the treatment of osteoarthritis, with the aim of repairing damage to the joint, stopping the condition getting worse and delaying, or even avoiding, the need for knee replacement surgery.

The painful joint condition affects more than eight million people and there is currently no effective drug therapy or treatment to prevent it or slow down its progression.

Around 100 people with early osteoarthritis in their knees are taking part in the three-arm, randomised controlled trial run by orthopaedic specialists at the Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust (RJAH) in Oswestry, Shropshire. The hospital is part of the £6m Arthritis Research UK Tissue Engineering Centre launched in 2011.

Stem cells versus cartilage cells

The ASCOT (Autologous Stem Cells, Chondrocytes or the Two?) trial is testing stem cells derived from bone marrow (also known as mesenchymal stem cells) versus cartilage cells called chondrocytes.

A combination of both types of cells will also be trialled. Chondrocytes alone have traditionally been used to repair small areas of cartilage damage.

The chondrocytes and bone marrow cells will be extracted from patients via keyhole surgery, grown in the lab and reimplanted back into the patient as part of the five-year £500,000 research programme.

Patients are only being recruited if their local orthopaedic surgeon or GP refers them to the RJAH, and strict eligibility

TECHNICAL ARTICLE

criteria are in place. It can only be offered to people who have previously undergone another surgical treatment, such as microfracture, which has failed to help their symptoms.

Professor Sally Roberts and Professor James Richardson

Participation in the trial involves two operations and a period of six months’ convalescence and rehabilitation. The Oswestry team will follow up the patients for 15 months and will measure success by looking at the quality of the cartilage and the patient’s ability to perform everyday activities. Some additional follow-up work will also be funded by a recently awarded grant from the Medical Research Council.

The research team, led by scientist Professor Sally Roberts and Professor James Richardson, professor of orthopaedic surgery, are keen to stress that this treatment may be more suited to some people than others.

Stem cells could reduce the need for knee replacement

“Hopefully the trial will help identify patients in the future who are likely to get most benefit,” said Professor Roberts.

“There remain many unanswered questions about cell therapy in general, for example, it is not known if stem cells may actually cure osteoarthritis (particularly at an early stage), or simply delay the need for a knee replacement.”

Professor Richardson said: “This trial has been a long time in the planning, partly due to changes in the regulatory environment, but this research remains exciting and novel. We are grateful to the Arthritis Research UK for their continued

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support and are very excited to be starting to recruit patients.”

RJAH director of research, Andrew Roberts, said: “I am delighted to support Professors James Richardson and Sally Roberts in the arthritis research work they are undertaking. The trial to improve on existing cell therapies, comparing the patient’s own chondrocytes and bone marrow stromal cells for the treatment of chondral defects, will depend on the continued collaboration of scientists and surgeons at the hospital. This is a traditional way of working at Oswestry, of which we are justifiably proud.”

For many years the RJAH has been at the forefront of using a surgical technique, originally pioneered in Sweden, called autologous chondrocyte implantation (ACI) which uses engineered cartilage cells taken from patients with cartilage problems – often caused by sports injuries.

Professor Richardson established special facilities for culture-expansion of autologous chondrocytes and marrowderived mesenchymal stem cells for cartilage and bone repair around 15 years ago.

Professor Richardson and Professor Roberts, whose academic base is at Keele University, have been instrumental in monitoring progress in the clinic, developing outcome measures for objective assessment of the procedures used and studying the biology of repair.

Their colleague Professor Alicia El Haj at Keele University is examining ways of controlling production of, scaling-up production and targeting of cells for tissue-engineered cell therapy.

The trial was originally due to start in 2010 but was delayed due to changes in the way that cell therapy products were regulated. Cell therapy products are now classified as drugs and so this trial is governed by the same regulatory processes as a drug trial.

Arthritis Today will keep readers up to date with the trial’s progress.

Stem cell trial: questions and answers

With Tim Knight, one of the surgeons involved in the ASCOT trial at the Robert

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Jones and Agnes Hunt Orthopaedic Hospital in Oswestry.

Has this kind of trial ever been performed before in the UK or elsewhere?

This is the first randomised clinical trial in the UK comparing different cell types in the treatment of cartilage damage. Other trials have been performed comparing cell treatments to more traditional operations, but the current quest is to define which types of cell work best.

Can you explain the differences between the three arms of the trial?

The three options are stem cells only (obtained from the patients’ own bone marrow),cartilage cells only (also called chondrocytes, these cells are obtained from the patients’ own knee) and a combination of stem cells and chondrocytes. Stem cells can be found in many places in the body. They are exciting as they have the potential to become any type of cell in your body, including cartilage, and they have even been used in some patients to treat early arthritis. Cartilage cells are found within the cartilage of normal knees and have been used, after being grown in the laboratory, to enable defects in cartilage to heal.

What do you hope this trial will achieve?

Cartilage defects in the knee can be painful and may not heal on their own: they may then lead to osteoarthritis. We want to help the body repair the defect by implanting cells that can enable the healing. However, it is not known which type of cell works best, or even if the combination of the two types will be best. This trial is designed to determine this.

It is important that patients do not know what treatment they have received so that expectations of any one treatment do not influence the outcome. All three options are considered in their own right to be potential winners and we need to make sure we do not bias our results.

Who is eligible to take part?

Patients with a symptomatic cartilage defect or early osteoarthritis, who are

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considered by their local surgeon to be suitable for cell therapy, are eligible. They must have tried simple keyhole treatments such as microfracture or debridement first and have an MRI scan to show where the cartilage and/or bone is damaged. (Microfracture is a surgical procedure in which small holes are punched into the bony surface of the joint, stimulating bone marrow cells from within the bone to form cartilage and cover the joint defect. Debridement involves the removal of loose debris around the joint).

How are you recruiting people to take part?

We are excited about this work but must also limit the resource to those who will benefit from it most. Just over 100 patients will be recruited to the trial according to their clinical symptoms and the amount of degeneration in their joint. For some people, a joint replacement will be the best treatment option. People wishing to take part must fulfil the above criteria and be referred to us via either their GP or preferably their orthopaedic surgeon.

Can you explain the surgical procedures involved?

All three arms of the trial will involve two procedures and will be performed by a team of orthopaedic surgeons at the Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust (RJAH). The first procedure is an arthroscopy, in which cartilage cells are taken from the cartilage and a small cut is made to remove bone marrow from within the hip.

An arthroscopy is a keyhole procedure where a camera is inserted into the knee joint through a few small incisions around the front and sides of the knee.

Through these small incisions samples of cartilage can be taken, small defects in the cartilage can be trimmed and other problems such as ligament damage can be repaired prior to the cell therapy.

A few weeks later, following the growth of the cells in the laboratory, a second procedure called an arthrotomy is performed. This is an open procedure on the knee joint, with an incision over the

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front of the knee. This leaves a wound and scar similar to those after a total knee replacement.

Do trial participants have to take part in rehabilitation after surgery, and if so, is it provided?

After the second procedure patients will be enrolled into an intensive physiotherapy regime. This will be a progressively active 12-month programme, gradually increasing weightbearing and range of movement. This will be carried out at the RJAH for patients local to Oswestry, but for those form further afield it will be undertaken via their local hospital. The regime will be very demanding and will require a high level of commitment.

How long is the trial and when we will know the results?

The trial is designed to run for five years; we will be recruiting patents (approximately 35 each year) in the first three and a half years and each patient will be followed up for at least 15 months.

Why is this type of surgery currently not available for people with advanced knee osteoarthritis?

Once the knee is severely damaged and sometimes inflamed with advanced arthritis, we believe that the cell therapy will fail. It may become possible in time to offer cell-based treatments to people with severe arthritis once we know which factors are most likely to dictate the success of the procedure.

Do you know how long the cartilage cells/stem cells implanted into the knee will last?

This is an interesting question but we do not know the answer. It is possible to label or ‘tag’ cells but so far these labelled cells have not been used for cell therapy. This may, however, become possible in the future as labelling and imaging techniques improve.

What if the surgery is not successful?

If surgery is not successful then more traditional treatment options will be available, for example, further microfracture can be performed or osteotomy, or eventually a knee

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replacement. Indeed, as with all treatment, there is no guarantee of success. Currently one in five cell therapies have failed and we are trying to identify factors that are linked to this.

If I take part in the trial will I be able to run/play sport/ski etc once I’ve recovered?

It is likely that the cell treatment will allow you to regain normal activity levels, but this can take up to a year and varies between individuals, and depends on the type of activity. For example, patients can return to swimming or cycling (which are good non-weight-bearing activities for Case study

Robin Griffin is pinning his hopes on the ASCOT trial to restore him to a level of fitness he used to enjoy before a serious rugby injury robbed him of an active lifestyle.

Robin, aged 42, from Ruthin, in North Wales, is one of 100 people with early osteoarthritis of the knee who is taking part in the trial at the RJAH, and will receive one of three treatments – stem cells taken from his own bone marrow, cartilage cells taken from his knee or a combination of both types of cell.

Robin’s knee problem goes back to his 20s when he played rugby for the local first team in Ruthin. During a game in South Wales he fractured and dislocated his right kneecap and spent eight weeks in plaster.

He says: “I was working full-time as a lifeguard at that time, and for the rehabilitation they told me to swim a lot and do some weights to try build muscle

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the knee) much more quickly than to contact sports.

How long will it be before this type of surgery is widely available on the NHS? This is a trial being run by an NHS foundation trust hospital, but only for patients to be treated here. More widespread availability will depend on the success of this trial and the willingness of other hospitals and companies to take it up. We would be delighted to see more people receiving treatments that resolve their pain with predictable and reliable results.

up. But it didn’t work – the muscle in my right knee is much weaker compared with my left knee. After a few years I started playing rugby again, but I wasn’t 100%, and never got back to the standard I’d been playing at before.”

Robin has an extremely high pain threshold and over the years attempted a variety of sports and managed to ski regularly, although he relied heavily on massive amounts of NSAIDs. He took a more officebased job as a health and safety advisor, which meant he spent less time on his feet.

But about four years ago he had to give up playing rugby and skiing as the pain and swelling in and around his right knee increased. He now he swims and cycles to keep fit but is still in constant pain.

“The pain varies from day to day depending on what I do; whether it’s hot or cold,” he says. “Sometimes swimming makes it worse, and just going up and down the stairs is a struggle.”

Robin had keyhole surgery at his local hospital in Abergele to wash out the knee joint and trim bits of loose cartilage, but its effectiveness was short-lived. However, his surgeon referred him to see Professor James Richardson at RJAH, who was just starting to recruit patients for the ASCOT trial.

“I had a couple of MRI scans and they decided it was worth my trying this treatment and going on the trial. Professor Richardson told me my kneecap was half a centimetre out of line. There is also some arthritis, and I have some bone growth

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around the kneecap area and on the kneecap,” he explains.

“So they will take some bone marrow samples, grow my cells and re-inject them back into my knee. Professor Richardson will also remove and reshape my kneecap and put it back in the correct position.”

Robin is keeping his fingers crossed that whatever treatment he receives as part of the trial, it will take away the pain, and enable him to be more active. Weighing over 16 stone, he is currently trying to lose a stone before the first of his operations in August. “I’d like to be as pain-free as possible and then I’d like to be able to rebuild the muscle around the knee area,” adds Robin. “I’d also like to be able to ski again after the treatment and operations.

“It sounds like fascinating research. You hear about stem cell therapies all the time, so to be involved in this trial is really exciting, and I hope this treatment will make a big difference to me and my quality of life. I’m happy to be a guinea pig!”

http://www.arthritisresearchuk.org/arthritisinformation/arthritis-today-magazine/165summer-2014/could-stem-cell-therapies-be-th e-answer-for-osteoarthritis.aspx

Dear Stakeholder representative, Please be advised that the draft guideline consultation period for the Medicines optimisation clinical guideline commences on 10th October 2014 and finishes on 7th November 2014.

Please note that the guideline's health economic plan, search strategies and review questions have been made available in advance of the draft guideline consultation. Below is the relevant link to these documents. http://www.nice.org.uk/Guidance/InDevelopment/ GID-CGWAVE0676/Documents Comments on these documents will be invited from registered stakeholders (http://www.nice.org.uk/guidance/gidcgwave0676/ documents/medicines-optimisation-stakeholderlist2) when the consultation begins on 10th October 2014.

Please note that Martin Harvey PG Cert BSc MCPodSurg MInstChP (Independent Prescriber/Consultant in Podiatric Medicine) is registered as a stakeholder for the podiatry profession and will be happy to pass on any comments. He can be contacted at bhapodiatric@btconnect.com

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Stylish Solution for Swollen Insteps and Ankles

The new Daisy-Mae shoe from Cosyfeet is low cut, making it ideal for patients with swelling across the foot or around the ankle. This dainty, feminine style is soft yet supportive and comes in a EEEEE+ fitting as standard.

This lightweight, leather shoe has a hardwearing sole with good grip for a firm footing. Its discreet, touchfastening strap can be easily adjusted and its seam-free toe area makes it ideal for problem toes. A soft collar also offers additional comfort and support.

The Daisy-Mae comes in sizes 3 to 9 including half sizes and is priced at £65.00 or £54.17 if patients qualify for VAT relief due to a chronic medical condition. It comes in a choice of Black, Bronze, Taupe, Beetle Red or Black Patent.

Strap extensions are available for especially swollen feet.

For more information see www.cosyfeet.com/daisy-mae or call 01458 447275.

Adjustable Winter Boot

New from Cosyfeet, these deep, roomy boots are made to fit problem feet without putting pressure on swelling, bunions or problem toes. Called the Sandra, they are designed to be ultra-comfy and come in a EEEEE+ fitting as standard.

These highly adjustable boots accommodate swollen feet and ankles and open all the way down to the toes, so they’re easy to get on and off. They have a removable comfort footbed to allow for orthotics if required, and provide built-in support around the ankle for extra stability.

Ideal for patients who have diabetes or sensitive feet, the Sandra has a combination of super-soft leather uppers, underfoot cushioning and seam-free linings that enclose the foot in protective softness. The lining is made from a sanitised material that allows the feet to breathe, combatting moisture and odour.

The Sandra is available in sizes 3 to 9 including half sizes. It comes in Black, Bottle Green or Claret and is priced at £79.00 (or £65.83 if patients qualify for VAT relief due to a chronic medical condition.) Matching strap extensions can be purchased for especially swollen feet.

For more information see www.cosyfeet.com/sandra or call 01458 447275.

Patients with extra wide or swollen feet? try

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Podiatry Review Vol 71:6

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All our boots benefit from: Roomy seam-free foreparts Adjustable touch-fastenings Wide openings for easy access Removable insoles or footbeds -making them ideal for orthotics

COSYFEET ARTICLE

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CPD ARTICLE

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DIABETES ARTICLE

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DIABETES ARTICLE

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OBITUARY

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OBITUARY

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OBITUARY

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Weird Medical Conditions We've all experienced some smarmy, icky incidents that make our skin crawl.

But there are people who actually think there are things crawling beneath their skin.

Morgellons Disease

Morgellons disease is a poorly understood condition in which people feel itching, biting and crawling under their skin. People with this condition also see filaments or fibers growing out of their skin, and can experience skin lesions, fatigue and memory problems, according to the Morgellons Research Foundation.

There is no known cause for the disease, but the Centers for Disease Control and Prevention started investigating potential causes in 2008. The medical community is divided on the disease some doctors say the symptoms are the result of mental illness, while others say the disease stems from a skin disorder, according to the Mayo Clinic.

Some health experts say the disease is caused by an unknown infectious agent.

But others say that idea is flawed, because most patients with Morgellons don't show evidence of an infection (such as elevated levels of white blood cells), according to a

study to be published in February in the American Journal of Clinical Dermatology.

Alien Hand Syndrome

The movie "Dr. Strangelove" tells the story of a man whose right hand seems to have a mind of its own. The strange condition is a reality for some people, and it's known as alien hand syndrome. People with the condition usually have a hand that reaches, grabs and holds onto things without the intention of the patient, according to a description of the syndrome in a 2004 article in the journal Archives of Neurology.

For example, a 1998 case reported in the Journal of Neurology, Neurosurgery and Psychiatry told the tale of an 81-yearold woman right-handed woman whose left hand was uncontrollable. Her left hand choked her neck and hit her face and shoulder involuntarily, and the woman also had sensory processing and visual problems.

A 2009 article in the Journal of Stroke and Cerebrovascular Diseases found that a stroke in the brain's right parietal lobe was the impetus for a case of alien hand syndrome. And an article published in

December in the journal PLoS One reported that parts of the brain that control voluntary movements may be uniquely activated in cases of alien hand syndrome.

Wiethe disease The case of a woman incapable of feeling fear has this disease, which is a rare genetic disorder that can lead to hardening of brain tissue, according to a 2010 report in the journal Current Biology.

As is the case with the woman in the study, known as SM, the disease destroyed her amygdala the almond-shaped structure in the brain that generates fear responses.

The woman was exposed to haunted houses, live snakes and spiders and films that would normally elicit a fearful response. But she didn't exhibit anything beyond a mild fear response to any of the stimuli. SM also didn't record anything indicative of fear in a daily journal she was required to keep.

The researchers said the finding could mean progress for treatments for posttraumatic stress disorder. http://www.livescience.com/35371-7weirdest-medical-conditions.html

New Evidence Update on infection from NICE

We are pleased to inform you that an Evidence Update on ‘infection’ has been published.

NICE Evidence Updates help to reduce the need for individuals, managers and commissioners to search for new evidence and keep health and social care professionals up-to-date with new research. While Evidence Updates do not replace current accredited guidance and do not provide formal recommendations, they do highlight new evidence that health and social care professionals may wish to consider alongside current guidance.

The new Evidence Update focuses on a summary of selected new evidence relevant to NICE clinical guideline 139 ‘Prevention and control of healthcare-associated infections in primary and community care’ (2012).

An Evidence Update Advisory Group, comprised of topic experts, reviewed the prioritised evidence and provided a commentary.

Your help in disseminating the Evidence Update to your members and colleagues would be much appreciated.

We would also welcome your feedback on the Evidence Update, what you like about it and how you think it could be improved.

You can send your comments through to contactus@evidence.nhs.uk.

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INFORMATION ARTICLE

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Plinth 2000 Addresses Obesity Crisis With Bariatric Range

The NHS is facing an obesity crisis, with the number of morbidly obese patients in Britain escalating three-fold since 1993, from 450,000 to 1.4 million. Also, according to the latest NHS figures, the number of people admitted to hospital because of their obesity has risen eleven times in a decade, increasing from 1,019 cases in 2001-02 to 11,736 in 2011-12.

A Daily Telegraph news report stated that ‘many hospitals have failed to invest in ‘supersize’ equipment suited to today’s morbidly obese patients’, recently prompting the NHS to buy uprated CT scanners for treating patients weighing up to 50 stone. This is the same safe working load adopted for a range of bariatric treatment couches and chairs developed

by Plinth 2000, to help tackle the obesity crisis and ensure safe manual handling guidelines are observed.

Every hospital department should have at least one heavy duty plinth, able to safely lift a morbidly obese patient to a suitable treatment height or position.

PRESS RELEASE

Suffolk-based Plinth 2000 leads the UK treatment table market in developing a range of bariatric products, currently offering 2, 3 and 4-section heavy duty couches, a divided leg trolley, podiatry chair and the first fully-rated 50 stone (320kg) tilt table, as well as a bariatric leg ulcer package with an uprated treatment chair.

A bariatric gynaecology couch is also about to be launched for the new generation of ‘plus size’ pregnant mothers, with a trendelenburg/reverse trendelenburg version also in the pipeline, which will enable even easier access for obese patients. A heavy duty dialysis chair is additionally in development, complementing the recently-launched standard chair, which has been designed with patient comfort and safety in mind, during prolonged dialysis treatment.

To ensure fitness-for-purpose, Plinth 2000 has totally reengineered all bariatric versions of its standard models, with heavy duty steel frames, reinforced selflubricating bearings, uprated electric motors and robust twin-wheel castors among the revised specifications.

Across the range, electrical height and angle adjustment allows even the heaviest patient to be positioned safely and

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comfortably, with optional battery back-up maintaining functionality in the event of power failure. Plinth 2000’s innovative bariatric tilt table breaks new ground with synchronised twin motors and linear actuators, to meet SWL (safe working load) ratings for tilting as well as lifting.

Deep, pressure-relieving comfort foam ensures prolonged comfort for heavier patients on all models, whilst ‘supersize’ seat widths, backrests, divided leg profiles and working platforms accommodate greater abdominal girth.

“In response to early demand from our client base and initial signs of an increasing prevalence of morbid obesity in this country, we were the first to introduce a bariatric treatment couch, our Model 50,” says Plinth 2000 founder and MD, Niall Dyer. “We have now built up the largest range of heavy duty chairs, couches and tables, with two new designs already in the pipeline. We are now keen to engineer further bariatric designs, providing there is customer demand.”

Further enquiries to Plinth 2000 at Wetheringsett Manor, Wetheringsett, Stowmarket IP14 5PP, tel 01449 767 887, email sales@plinth2000.com, www.plinth2000.com

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Podiatry and Online Marketing - whatclinic.com One of the fastest, simplest ways to find new patients is to be found online.

In the past five years, the way patients find and book podiatry appointments has changed. It’s simply not enough to be listed in the phone book anymore, it is essential to have an online presence.

This added layer of work requires time and expertise, but it does pay off.

According to Google trends, the number of people searching online for podiatrists has never been higher, with annual peaks in summer months.

There are a number of ways to be found online. Apart from a website and social media channels you can also create a free listing on WhatClinic.com.

There are approximately 870 podiatry clinics listed on the healthcare search engine, and according to The Guardian (June 2014) 15.7 million people used the site last year to find and compare clinics in their preferred location. The site has reported a 137% increase in online demand for podiatry consultations in the past 12 months.

WhatClinic.com works very much like a website in that it’s a good place to advertise opening hours, contact details and availability. It has a number of features that are of interest: • A free booking widget that you can paste on to your own website, so patients can see your availability and request available times (there’s a version for Facebook too).

• A dashboard that lets you review all phone and email enquiries made through the site, or through the widget. This tracks and records phone numbers, email addresses, call durations and response times.

• Free SMS confirmation and reminder service.

• Patient reviews section. Every listing has a section for reviews. Each review is verified by phone and email to ensure they are genuine.

What makes it useful is the volume of patients that use it every day to search for clinics near them. It’s free to add your clinic and have a listing, and even better, it’s free to use the booking widget, as long as you keep your availability up to date, and get back to the patients on the same day. There are premium packages available on the site, but all of the features above are free to use. It takes about 5 minutes to create a listing on the site.

It’s a great idea to put yourself in the customer’s shoes (no pun intended) and search online for your own business.

Search for podiatrists in your local area.

Is your information easily found?

Six Top tips for managing online presence:

#1 Make sure your website is being indexed by Google.

#2 Register your business on Google maps, and verify the address is correct. #3 Make sure your contact phone number is on every page of your own site (and that it’s clickable, so that people visiting your site on a mobile phone can easily connect to it)

#4 Show your availability online. It has been proven that patients prefer clinics that present available times and booking tools on their website. #5 Make sure you take advantage of high traffic sites like Facebook and WhatClinic.com to have as many chances as possible to be found by patients in your area.

#6 Encourage satisfied patients to write reviews for your business. More and more patients are looking for recommendations to help them choose a practitioner.

Visit the Member’s Area on the Institute’s Website www.iocp.org.uk/members Not got a password? Request one on-line or phone 01704 546141 page 27

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WHAT CLINIC

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Landlords and Property Owners Urged To Comply With New Legionella Legislation or Face Prosecution Landlords and property owners now face hefty fines if they fail to comply with the latest legionella legislation recently updated by the Health & Safety Executive.

The revised legislation deals with the control of risks associated with legionella, a water-borne bacteria, which although rare, can have serious and often fatal consequences if it develops into Legionnaire’s disease. With the help of specially designed tools from Legionella Control International, landlords and property owners can now take appropriate steps to mitigate the risks and ensure the safety of their tenants.

The legionella experts offer a series of free guides and check-lists to assist landlords, property owners and managing agents control these risks.

Their “Legionella Compliance Self-Audit Checklist” is one such tool which is free for landlords and available to utilise on request.

Legionella is typically found within aquatic environments and is especially dangerous where specific conditions enable the micro-organisms to propagate speedily. Legionnaires’ disease itself is rare but 359 reported cases were diagnosed during 2010 in England and Wales alone.

Landlords, property owners and managing agents are encouraged to implement risk

INFORMATION ARTICLE

assessments and water management systems to ensure that impending risks are minimised or eliminated altogether.

Landlords have been urged to watch for especially vulnerable individuals who may be further susceptible to contracting the disease when exposed to contaminated water systems.

Rob Boob, Legionella Risk Management Specialist and Head of Legionella Control International’s London team said, “Although outbreaks of Legionnaires’ disease are rare, the ramifications are real and can be devastating to those involved.

It is essential that landlords, property owners and managing agents satisfy their legal obligations to ensure that legionella is not ignored and left unmanaged within their properties. Fortunately, it is relatively easy to implement appropriate risk management strategies to ensure that the bacteria does not get a hold. UK tenants and businesses require complete compliance in this area which is why those that fail to comply with the law can face hefty fines.”

The HSE issued a revised addition of the Approved Code of Practice entitled, “Legionnaire’s Disease: The Control of legionella bacteria in water systems” to ensure that property owners manage any risks appropriately. The scheme must be

Podiatry Review Vol 71:6

enforced by all within the property sphere regardless of the size and complexity of their water systems.

Legionella Control International ensures world class solutions are implemented to minimise, control and prevent the risk of legionella outbreaks in private and commercial properties.

Offering independent, impartial advice, they offer landlords and property owners an extensive range of legionella risk management services including risk assessments, compliance audits, training, assessment of water systems, crisis management, and laboratory testing as well as an array of other essential options all designed to safeguard against legionella.

To find out more about Legionella Control International and how to safeguard your property to comply with the legislation, visit: http://legionellacontrol.com/

About Legionella Control International: Legionella Control International is a UK based company specialising in offering world class solutions from risk management experts to help landlords and businesses safeguard against the risks of legionella. Their independent, impartial advice enables people to control, manage and prevent the likelihood of outbreaks.

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BRANCH NEWS

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Western Branch Meeting Hazel Carruthers

On Sunday 14th September fifteen fortunate members of the Western branch gathered together at the Liverpool Women's Hospital for a truly interesting, informative branch meeting.

Thanks to the efforts of Dawn Hinton, we were introduced to Gemma Glen who is the Advancis medical representative for the North West region. Advancis is a British manufacturer of wound care products. Gemma explained to us the amazing benefits of using Manuka honey in the medical profession in the form of dressings and topical preparations but also as a health benefit for the individual.

After a short refreshment break the meeting continued with the business in hand. We discussed Institute matters, treasury reports, future cpd and put dates in our diaries for upcoming events.

The meeting then concluded with a talk from the founders of "Foot Essentials" , which is a range of specially developed and blended aromatherapy oils designed specifically for foot related problems. Podiatrist, Debra Hughan and Aromatherapist, Sheila Hood developed the aromatherapy oils for the conditions we as podiatrists encounter in our profession on a daily basis. We had the opportunity to try the oils and creams available and purchase them as required.

As a very happy member of the Western branch I would like to thank all the members that pull together to make the meetings friendly and enjoyable and would encourage more of our members to attend, make friends and gain valuable cpd.

North West Branch Meeting 9th September

North West Branch held their autumn meeting on the 9th September at their regular venue in Chorley. Attendance was slightly down on the usual numbers but those who were there enjoyed a lively and informative meeting.

The business was preceded by a presentation by Julie Janeczko, national sales executive for Reed Medical, who was introducing their Solace range of footwear for the rheumatoid foot. We are all aware that the usual footwear provided for rheumatism sufferers can hardly be called stylish and this brings with it the problems of patient dissatisfaction and consequent non-compliance. In fact Julie quoted the statistic that eighty percent of rheumatoid arthritis sufferers are dissatisfied with their footwear. How refreshing then to see a company tackling the problem by producing shoes that are patient specific with lasts specially designed for the rheumatoid foot but that are definitely stylish.

After a short break for coffee the business was conducted for the last time in the hands of our Chairman, Alan Carr, who is stepping down and whose experienced guidance will be greatly missed. The branch also noted with regret the passing of John Patterson, another driving force in the development of the Institute locally. Despite the bad news there was plenty to cheer us along and the meeting finished on an optimistic note as we all look forward to our branch AGM in January.

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Some of North West Branch members engaging in CPD.

A note for all Branch Secretaries

In order for details of branch meetings to appear in Podiatry Review would you please send them in via email to bernie@iocp.org.uk by the FIRST day of the preceding month to publication.

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Classified PRACTICES FOR SALE

Historic, beautiful, Exeter, Devon

Domiciliary practice; est 1993. Due to retirement/health.

2.5 day week, earning 14k. Accounts available. Previously full time, scope to re expand!

Good opportunity for re-location!

Open to offers. Initial support given.

Help with accommodation if necessary.

Tel 01392 253066/07988477338 email jan_rolfe@sky.com

Thriving seaside practice, Seaford, East Sussex. Established over 40 years, excellent reputation. Within Osteopaths clinic, good referrals. 3 days per week, plus Saturdays, late nights if wanted. Over 400 patient goodwill list. All equipment, instruments included.

Annual turnover 24k. OIRO 20k Tel: 01323 489437 07928 467748 Email jmcpod@aol.com

Business for Sale in Cheshire

15 year old established podiatry and chiropody practice for sale due to unexpected death of proprietor. Two leased premises in areas with a large retired community – Holmes Chapel and Sandbach, Cheshire. Owner well respected in local community and Director of Institute of Chiropodists and Podiatrists for many years. Sale includes patient database, equipment and stock.

Laser machine also included. Turnover c£20k with potential for expansion.

Telephone 07721 302566 or email helenandnoel@btinternet.com

The launch of getmehealth.co.uk in Oct 2014 will provide a further platform on which members of the IOCP can enhance their current marketing activities (a predicted 10 million hits) year to Nov 2015 to a waiting audience of potential patients requiring treatment falling outside the remit of the NHS or at best incurring extended waiting time. Registration is free with the option to offer a discount of 5% (producing a smiley face next to your details). Take a look at the website.

Please remember to include your HCPC number where applicable to be included in the relevant heading.

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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)

Seaford, East Sussex

Free Advertising for our Members and Associates

Chiromart UK “WHY PAY MORE?”

DES CURRIE INTERNATIONAL (+44) (0) 1207 505191

Business Cards 1 sided; ..................1,000 - £40 ......................................................10,000 - £99 Record Cards/Continuations/ Sleeves (8” x 5”) ..................................1,000 - £68 Appointment Cards 2 sided; ........10,000 - £99 Small Receipts ................................2,000 - £49 ........................................................4,000 - £71 Flyers ............................................10,000 - £82 + type setting + carriage

FOR ALL YOUR STATIONERY NEEDS

SVTS Chiropody Drill Repair and Sales

We offer an excellent competitive and efficient repair service for all makes of Podiatry/chiropody drills. Berchtold, Hadewe, Suda, Footman, Podo Tronic and Podo Pro EVO-30, 40, 50 drills.

WE ALSO BUY YOUR UNWANTED DRILLS. Unit 239 Stratford Workshops Burford Road London E15 2SP

Contact us on 02085190044 or www.chiropodydrillrepair.co.uk

Podiatry Review Vol 71:6

CLASSIFIED

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Classified VACANCIES

HCPC Registered Podiatrist

Leading Private Podiatry Practice in the East Midlands with large fast growing client base providing full podiatry services.

Excellent environment and working conditions and a great opportunity to develop your skills and experience.

We are looking for a HCPC registered Podiatrist who is self motivated, confident, with excellent interpersonal skills.

Able to work in a team environment.

Contract is to be on a fee sharing basis.

Replies to biopod1@googlemail.com

EXCITING JOB OPPORTUNITY EAST SUSSEX

Multi-disciplinary clinic team with an in-house fully calibrated gait lab www.strideuk.com This is a self employed role where our 11 strong team can cross refer patients.

If you are interested in being part of a professional, busy and dynamic company. Good communication and an excellent professional working manner is imperative.

Please register your interest.

http://www.studio57clinic.co.uk/content/jointeam57

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Put it in your diaries now!

29th and 30th May 2015

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CLASSIFIED

Podiatry Review Vol 71:6

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AGM BOOKING FORM

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Please se www.ioc e website calend p.org.uk a for late e r ntries

November 2014 2

12 16

23

23

23

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Midland Area Council Meeting Kilsby Village Hall, Kilsby CV23 8XX Tel: 01536 269513

13

London Branch Meeting Ozzie Rizzo, 14 Hay Hill, Mayfair W1J 8NR Tel: 07956 962744

West of Scotland Branch Meeting 10.00 am – 4.00 pm - O N E DInn Express, Springkerse P Holiday T S O P Stirling FK7 7XH Business Park, Tel: 0141 632 3283 Essex Branch Meeting 2 pm - Southend University Hospital Education Centre, Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890 Leicester & Northants Branch Meeting 9 am - Lutterworth Golf Course (refreshments 8.45) CPD Lecture: TBC Trade Stands to be arranged.

Tel: David 01455 550111 South Wales Branch Meeting 2 - 4 pm - The Village Hotel, Coryton, Cardiff Tel: 01656 740772

December 2014 5 7

Hants and Dorset Branch Christmas Social event - Details to follow Tel: 01202 425568

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Leeds/Bradford Branch Meeting 10 am - Oakwell Motel, Birstall, WF17 9HD Tel: 01423 819547

24

January 2015

25

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Teeside AGM 11am - Tel: 01287 639042 for further details

Western Branch AGM & Meeting 12.00 noon - Blair Bell Education Centre, Room 1, Liverpool Women’s Hospital, Crown Street, L8 1SS Business meeting followed by presentation - TBA. Also John Rose will be calibrating autoclaves and traders will be invited.

Tel: 01745 331827 Wolverhampton Branch AGM 9.30 am - 4 Selmans Parade, Selmans Hill, Bloxwich W53 3RN. Tel: 0121 378 2888

DIARY OF EVENTS

Surrey and Berkshire Branch AGM Pirbright Village Hall GU24 0UE Tel: 0121 378 2888

North West Branch AGM St Joseph’s Parish Centre, Harpers Lane, Chorley PR6 0HR Tel: 01257 411272 Hants and Dorset AGM Romsey Tel: 01202425568

Birmingham Branch AGM 7.30 pm - Red Cross Centre, Vine Street, Evesham, Worcs. Tel: 01905 454116

Essex Branch AGM 2 pm - Southend University Hospital Education Centre, Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890 Cheshire North Wales, Staffs and Shropshire AGM 10 am - The Dene Hotel, Hoole Road, Chester, CH2 3ND Tel: 0151 327 6113

Devon and Cornwall Branch AGM and Meeting 11am - The Exeter Court Hotel, Kennford, Exeter, EX6 7UX Lecturer to be confirmed. Tel: Mark Smith 01803 520788 or email mrkjoanne@aol.com for further details.

West of Scotland Branch AGM 11.00 am – 1.30 pm - Holiday Inn Express, Springkerse Business Park, Stirling FK7 7XH Tel: 0141 632 3283 Nottingham Branch AGM 10 am - Feet and Co 85 Melton Road, West Bridgford, NG1 6EN Tel: 0115 931 3492 Southern Area Council AGM Victory Services Club

Leicester and Northants Branch AGM Lutterworth Cricket Club Starts 10am with refreshments at 9.45am Contact Sue 01530 469816 South Wales Branch AGM 2 – 4 pm - Venue to be confirmed Tel: 01656 740772

February 9

Midland Area Council Meeting Kilsby Village Hall, Kilsby CV23 8XX Tel: 01536 269513

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Bookings Now Being Taken

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INFORMATION ARTICLE

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INFORMATION ARTICLE

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