Podiatry Review July/August 2013

Podiatry Review

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 1

ISSN 1756-3291

Volume 70 No.4. Published by the Institute of Chiropodists and Podiatrists as a Peer Review Journal July/August2013

• Conference Photos and Reports • The facts about Lyme Disease • Common Food Myths

The Institute of Chiropodists and Podiatrists

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 2

NATIONAL OFFICERS

National Officers President

Mr R Henry F.Inst.Ch.P, DChM

Chairman Executive Committee Mrs C Johnston MInstChP BSc(Hons)

Vice-Chairman Executive Committee Mr A. Reid M.Inst.Ch.P

Chairman Board of Ethics Mrs J. Dillon MInstChP

Chairman Board of Education

Mr R Sullivan BSc.(Hons) Podiatry, MSc. Pod Surg,.

PgDip Mio.Acu,.FIChPA. M.Inst.Ch.P.

Vice-Chairman Board of Education Miss Joanne Casey MInstChP BSc

Honorary Treasurer Mrs J Drane MInstChP

Standing Orders Committee

Mr M. Hogarth MInstChP Mrs L. Pearson MInstChP BSc Pod Med

Secretary

Area Council Executive Delegates Miss A. J. Burnett-Hurst

Midland Area Council

Mr S. Miah BSc. (Pod M), M.Inst.Ch.P

North West Area Council Mrs M Allison MInstChP

Republic of Ireland Area Council Mrs J Casey MInstChP BSc

Scottish Area Council Mr A Reid MInstChP

Southern Area Council

National Officers Area Council Executive Delegates Branch Secretaries

Branch Secretaries Birmingham

Mrs J Cowley

01905 454116

Devon & Cornwall

Mr M. Smith

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Cheshire North Wales East Anglia

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Mrs J Doble

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Mrs B Wright

Leeds/Bradford

Mr N Hodge

London

Mrs F Tenywa

North of Scotland

Mrs S Gray

Hants and Dorset

Leicester & Northants North East

North West

Northern Ireland Nottingham

Republic of Ireland Sheffield

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Mrs J Sadler

Essex

Mrs S J Foster

Mr A Thurkettle Mr B Massey

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Western

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West of Scotland

Mr S Gourlay

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Surrey and Berkshire Teesside

Mr D Crew OStJ, FInstChP, DChM, CertEd

West Middlesex

Mrs J Dillon MInstChP

Wolverhampton

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 3

J U LY/A U G U S T 2013 V O L 70 N o.4

Editor Ms B. Hawthorn H.M.Inst.Ch.P.

Academic Editor Robert Sullivan BSc.(Hons) Podiatry, MSc. Pod Surg,.

PgDip Mio.Acu,.FIChPA. M.Inst.Ch.P.

Advertising Please contact Julie Aspinwall secretary@iocp.org.uk

Published by The Institute of Chiropodists and Podiatrists 150 Lord Street, Southport Merseyside PR9 0NP 01704 546141 www.iocp.org.uk

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PODIATRY REVIEW

The Institute of Chiropodists and Podiatrists

Contents

Gout

Michelle Taylor M.Inst.Ch.P., BSc ......................................4 Tendon and Tissue Problems of Foot and Surrounding Tissues

Iain B. McIntosh BA(Hons) MBChB. FFTMRCGPS (Glas)....6 The Facts about Lyme Disease

Lyme Disease Action..........................................................8 Obituary

Francis Roland Hale .........................................................12 Awareness Day

Hepatitis Facts .................................................................14 Printed by Mitchell & Wright Printers Ltd, The Print Works, Banastre Road, Southport PR8 5AL 01704 535529

ISSN 1756-3291

Annual Subscription

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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.

The Truth about Food Myths

NHS Choices ....................................................................16 Arthritis News

Arthritis Research UK ......................................................21 City and Guilds Graduation photographs ........................22 Acting President’s address to members ..........................23 2013 Trade Show Information.........................................24 Branch News ...................................................................26 Classified Adverts ............................................................33 Diary of Events ................................................................36

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 4

EDITORIAL Dear Readers, What a wonderful conference, trade exhibition and awards dinner, we have recently hosted at the Southport Convention Centre. From the extensive positive comments received, it seems that most of you thoroughly enjoyed this annual event. We are very lucky and proud to have such a prestigious conference centre on our doorstep, with its large airy rooms and easy access for trade, not to mention convenience for the town centre with its numerous hostelries, restaurants and shops. We are already planning the 2014 event in the same place!

Due to time constraints we are not able to publish your letters and emails in this issue, however, do please keep them coming as we will publish all in the next issue. Feedback is always appreciated – good and bad, in order that we can continue to improve year upon year.

Our business side of the event saw us welcome Colette Johnston (Northern Ireland branch) as Chairman of the Executive Committee; Alisdair Reid (West of Scotland branch) as vicechairman Executive Committee; Roger Henry (Devon and Cornwall branch) as President; Joanne Casey (Republic of Ireland branch ) as vice-chairman Board of Education and Julie Dillon (Leeds/Bradford branch) as Chairman, Board of Ethics.

We would also like to welcome Somaz Miah (Wolverhampton) branch who has taken over as Midland Area Council representative to the Executive Committee.

We say goodbye to Malcolm Holmes (Cheshire North Wales branch) who did not stand for election on this occasion and to Stephen Willey (Sheffield branch) who will be leaving us when our chiropody clinic in Southport closes it’s doors at the end of this month. Both gentlemen were instrumental in the transition of Head Office from Wright Street to Lord Street for which we, the office staff, thank them most sincerely……..and guys… we hear Pickfords are looking to recruit!!

At conference, it was my proud honour to award Michelle Taylor the Basham literary prize for her contribution to Podiatry Review in 2012. Michelle has been a constant help over the past twelve months or so in producing technical articles. If any other member wishes to follow Michelle’s example, please take the plunge! Remember, our profession is due to be audited in 2014 and writing articles counts as much (if not more) to your CPD profile as attending lectures!

02 | page

Editor and dancing partner

In this issue Michelle has supplied us with an article on Gout.

Although Gout is by no means a ‘new’ condition, it has become much more common in recent decades; thought to be as a result of richer diets and longer life spans.

We are also pleased to present another fascinating article by Iain B. McIntosh, former chiropody schools inspector, on Tendon and Tissue Problems of the Foot and Surrounding Tissues. Iain’s articles are always well received and informative.

Now that summer (hopefully) is well and truly under way we have been made aware that Lyme Disease is on the increase.

Lyme Disease is often difficult to diagnose and people need to be more aware of the signs as well as preventative measures to prevent being bitten by ticks. We thank Lyme Disease Action for their help in compiling our article on page 8. By being more aware you may just be able to save a patient from serious illness as swift diagnosis is the key to complete recovery without complications.

Another interesting feature is that of the myths surrounding food! How often do we hear that certain foods are good for us whilst others are bad only to have this reversed in subsequent reports? The article starting on page 16 makes thought provoking reading.

We would also like to thank all the branches for their seminar information. Please remember you are welcome to attend any branch for their CPD events.

Booking forms or details are supplied and branch news commences from page 26.

The Institute wishes all our members a very happy summer.

Bernadette Hawthorn, Editor

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 5

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 6

TECHNICAL ARTICLE

Gout

By Michelle Taylor M.Inst.Ch.P B.Sc. In 1998 Till and Snaith stated that gout is one of the oldest forms of arthritis. It is the most common inflammatory arthritic condition to affect older people. With 3% of those aged over 65 affected, males are up to 6 times more at risk than females (Menz, H.B. 2008). Gout is a disease in which there is defect within the uric acid metabolism, causing an excess build-up of uric acid and urates (salt) within the bloodstream and the synovial joints (Concise Medical Dictionary 2002). Medical conditions including high blood pressure, high cholesterol, diabetes, heart or kidney problems raise the risk of developing gout, along with the use of diuretics [Standards of Care for people with Gout accessed14.2.2013].

Crystal arthropathies gout and pseudo gout are the clinical manifestations of the inflammatory response due to crystal

deposits in the synovial joints. Pseudo gout is not that common and is predominantly a disease of the elderly (Lorimer, D. et al 2006). Pseudo gout is caused by deposits of calcium pyrophosphate crystals within the affected joints – usually the knee, wrist or shoulder. Calcium pyrophosphate crystals enter the joint space and are taken up by the white cells causing a similar presentation to gout (Menz, H.B. 2008).

Gout or acute inflammatory arthritis is primarily due to raised blood urate levels within the bloodstream (Lorimer, D. et al 2006).

This impaired secretion of monosodium urate crystals deposited within the peripheral joints is a by-product of the purine metabolism. An accurate diagnosis between pseudo gout and gout can be made via microscope examination of the synovial fluid (Menz, H.B. 2008). The 1st metatarsophalangeal joint is initially affected in 50% of cases, while 90% of people develop this manifestation during the course of the disease. It is thought that due to the low temperatures that this joint is exposed to combined with large compressive forces while walking; contribute to the formation of monosodium urate crystals. Other joints affected include the metatarsophalangeal joints, ankle and knee joints (Menz, H.B. 2008).

Classification of acute arthritis of primary gout is made using the 1977 (American College of Rheumatology) ACR criteria: • More than one attack of acute arthritis

• Maximum inflammation developed within 1 day • Mono - arthritis attack

• Redness observed over joints

• First metatarsophalangeal joint painful or swollen • Unilateral first metatarsophalangeal joint attack • Unilateral tarsal joint attack

• Tophus (proven or suspected) • Hyperuricemia

• Asymmetric swelling within a joint on x ray* • Subcortical cysts without erosions on x ray

• Monosodium urate monohydrate microcrystals in joint fluid during attack • Joint fluid culture negative for organisms during attack

The clinical course of gout is fairly predictable and is divided into 3 main stages: • Asymptomatic hyperuricemia.

• Acute gout and “intercritical periods” • Chronic tophaceous gout.

Asymptomatic hyperuricaemia is the 1st stage of gout in which 04 | page

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 7

TECHNICAL ARTICLE the serum urate levels are raised. At this stage there are no clinical features of gout present [Standards of Care for people with Gout accessed 14.2.2013].

Acute gout can be interspaced with intercritical periods of no

activity of gout. Initially acute gout presents as a severe and

acute form of mono arthritis lasting a few days (Lorimer. D. et al

2006). The length of intercritical periods vary but tend to be short in poorly controlled gout. With 75% of patients suffering a 2nd

attack of gout within 2 years of the 1st (Harris, M.D. et al 1999).

Clinical features for diagnosing acute gout include: • 1st MTP joint involvement.

• Rapid onset of severe joint pain over 6 – 12 hours.

• Joint swelling and tenderness.

• Overlying erythema.

• Self-limiting with complete resolution.

• Tophus (proven or suspected).

[Standards of Care for people with Gout accessed 14.2.2013].

These drugs should be started 7 to 14 days after an attack has settled (BNF 64 September 2012).

In order to reduce the incidences and recurrence of gout, lifestyle changes are recommended, include reduction in weight with crash or Atkins type diets avoided. A diet rich in skimmed milk, low fat yoghurt, soya beans, vegetables and cherries should be encouraged. While food high in purine, red meat – liver, kidney – shellfish and yeast extract should be restricted. Alcohol consumption should be restricted to less than 21 units per week for males and 14 units for females. With at least 3 alcohol free days per week, with beer, stout and fortified wines avoided.

Herbal remedies are actively discouraged from being used due to the inference with the prescribed medication for gout.

Affected joints should be elevated and exposed to cold environment with the use of ice packs encouraged. Intense physical exercise should be avoided to affected areas while moderate physical exercise should be encouraged (Jordan, K.M et al).

Prior to an acute attack, there are preceding factors which can

contribute to an attack which can include; • Dietary changes.

• Alcohol changes.

• Minor trauma to the joint.

(Weinfeild, S.B. et al 1998)

Chronic tophaceous gout is caused by the formation of solid

urate deposits – tophi – in the connective tissues, predominately of the fingers, toes, elbows and ears.

Older women are

predisposed to this stage of gout partly due to higher levels of diuretic use (Menz, H.B. 2008). Initially the joint spaces are preserved but erosions of the joint are common. These deposits can be quite large, which can lead to problems with shoe fitting

especially if they develop within the foot. Occasionally large tophi can cause ulceration (Weinfeild et al 1998).

Management of acute gout includes resting of the affected

joints, analgesic pain relief, anti – inflammatory drug therapy which requires an immediate start for 7 to 14 days of treatment

(Jordan, K.M. et al 2007). Frequent recurrently attacks of acute

gout with the presence of tophi or signs of gouty arthritis may call for long term treatment. The formation of uric acid from

purines may be reduced with xanthine – oxidase inhibitors allopurinol or febuxostat, or the use of uricosuric drug sulfinpyrazone to increase the excretion of uric acid within urine.

Treatment should be continued to prevent further attacks of gout.

References BNF 64 September 2012

Concise Medical Dictionary.3rd Ed Oxford University Press.

Standards of Care for people with Gout http://arma.uk.net/wp-content/uploads/pdfs/Gout.pdf [accessed 14.2.2013]

Harris, M.D. Spegel, L.B. Alloway, J.A. 1999. Gout hyperuricemia. American family Physician 59 (4):925 – 934.

Jordan, K.M. Cameron, S. Snaith, M. Zhangh, W. Doherty, M. Seckl, J. Hingorani, A. Jaques, R. Nuki, G. (2007) Guideline for the Management of Gout. British Society for Rheumatology and British Health Professionals. Oxford University Press.

Lorimer, D. French, G. O`Donnell, M. Burrow, J. G. Wall, B. (2006) Neale’s Disorders of the Foot. 8th ed. Churchill Livingstone Elsevier.

Menz, H.B. (2008) Foot Problems in Older People. Assessment and Management.

Churchill Livingstone Elsevier.

Till, G.H. Snaith, M.L (1998). Gout, Hyperuricaemia and Crystal Arthritis. British Journal of Podiatry 53 (1) 3 -6.

Wallace, S. L. Robinson, H. Masi, A. T. Decker, J. L. McCarty, D.J. Yü, T.F. (1977).

Preliminary criteria for the classification of the acute arthritis of primary gout.

Arthritis Rheum (20):895 - 900.

Weinfeld, S.B. Schon, L.C. (1998) Hallux metatarsophalangeal arthritis. Clinical Orthopaedics and Related Research (349) 9 – 19. http://www.myfootshop.com/images/

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 8

TECHNICAL ARTICLE

Tendon and Tissue Problems of Foot and Surrounding Tissues

By Iain B.McIntosh BA(Hons)MBChB.FFTMRCGPS(Glas) Former Chiropody Schools Inspector.

Tendon, musculo-skeletal foot and ankle problems are not uncommon and can cause significant impairment with walking and function. Surveys report that about 22% of the population complain of experienced foot pain in the previous month and 60% have had an episode of foot pain in the last six months. Hallux valgus, corns, calluses and nail pathologies are often found on general medical examination. Age, obesity, female sex, peripheral arthritis and diabetes mellitus are all associated with foot pathology.1.2 These problems are associated with decreased ability in activities of daily living, reduction in walking speed, disturbed balance and an increased likelihood of falls. Foot disturbance if untreated can have a considerable effect on well-being beyond the related pain and discomfort. The conditions can become chronic, for instance, Achilles tendinitis can become a tendinosis and last for periods up to two years with crippling effect, before healing ultimately occurs. Ankle, heel, toes and forefoot are most affected by musculo skeletal problems .Relatively few patients consult medical professionals about them and not all seek the attention of a podiatrist. There is a tendency for individuals to dismiss the symptoms and soldier on in the hope that time will solve the problem.

Heel pain is responsible for about a third of GP foot and ankle consultations. Pain from the postero-superior aspect of the calcaneous bone often relates to prominent exostoses on the superior border of the bone, sometimes known as a Hagland deformity,or a “pump bump”. Repeated dorsiflexion of the foot causes friction between the exostosis and the Achilles tendon near its insertion. This results in tendinopathy and inflammation of the retro calcaneal bursa and a syndrome of retrocalcaneal bursitis, exacerbated by footwear with a hard heel counter and exercise, particularly running up hill.3 Management aims to reduce the inflammation and mechanical irritation .The patient should avoid footwear with a rigid heel counter and use accommodative padding. Local inflammation 06 | page

may be reduced by ice applications, stretching exercises and antiinflammatory medications. If this fails, heel lifts or functional orthoses may be required.

Plantar heel pain is common and often caused by plantar

fasciitis. The patient complains of pain in the region of the medial calcaneal tubercle. This is worse on weight bearing first thing in

the morning and typically settling after walking a few steps, before returning with prolonged weight bearing. Clinically a

localised area of inflammation can often be felt along the anteromedial border of the calcaneous at the attachment of the plantar fascia.

The main treatment involves stretching of the plantar fascia

and the Achilles tendon, with the former thought to be more

beneficial. Low-Dye adhesive taping helps to relive pain if applied for a short period of 4-5 days. There is evidence that foot

orthoses offer symptom relief over longer times of several months but are no better than placebo if the condition lasts

longer than a year. Although plantar and posterior heel pain is mainly of mechanical origin, the health professional should be aware of the possibility of underlying systemic

disease.

Attachments of tendons and fascias in this area are often the site of arthropathies, such as spondylitis and arthritis. If there are doubts as to causation the patient should be referred to a primary care physician.4

Pain in the forefoot .This accounts for about 20% of non

traumatic gp consultations. Pain in the ball of the foot is often referred to as metatarsalgia which is a description and not a

diagnosis. Atrophy of the intrinsic small muscles of the foot along with the plantar fat pad is common in elderly people, causing in loss of cushioning under the metatarsal heads with resulting

areas of increased pressure in the forefoot and accompanying pain . Cushioning shoe insoles can often relieve symptoms and

advice to the patient as to the cause often relieves the worry that this is a more serious condition.5.6

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 9

TECHNICAL ARTICLE Occasionally a benign Morton’s neuroma of the inter-

Simple conservative measures practised by the podiatrist can

metatarsal nerves can occur where they branch into the plantar

alleviate if not cure. The paring away of keratotic skin and the

fourth metatarsal space and may be due to repeated trauma to

pain relief and avoids the appearance of associated septic corns.

digital nerves. Often seen in women, they appear in the third and the nerve and surrounding connective tissue. Patients complain

of pain of sharp or burning nature, in the plantar aspect of the foot and inter-metarsal space at the level of the metatarsal head,

or they feel they are walking “on a lump” or small stone. Clinically

pain can be elicited by squeezing the metatarsals together in a medial-lateral direction and applying pressure to the intermetatarsal space by thumb. Sometimes this procedure

brings an audible click which arises from the displacement of the

neuroma from the inter-metatarsal space. Treatment involves patient education regarding the wear of flat footwear with adequate width in the forefoot and a well cushioned sole.

Orthoses can be helpful and metatarsal pads placed proximal to

the neuroma may reduce compression between adjacent

metatarsal heads and reduce symptoms. Conservative measures

such as these are effective in bringing relief in 40% of cases. If there is no resolution, the neuroma may have to be excised by a surgeon with an 80% success rate.7

Hallus valgus(the bunion) occurs in 36% of people aged over 55

years. They are not a benign condition as they can be painful. As

this deformity progresses lateral deviation of the hallux and has an impact on quality of daily living. Clinically there is lateral

displacement of the hallux accompanied by medial deviation of

the first metatarsal resulting in progressive subluxation of the first

mtp. joint. As the deformity progresses lateral deviation of the hallux begins to interfere with the normal alignment of lesser toes causing hammer toe or claw deformities. Pressure from footwear then causes painful hyperkeratotic lesions –corns and calluses -on both plantar and dorsal aspects of the foot, an adventitious bursa on the medial prominence of the bunion can also develop.

There is a multifactorial causation with 90% of people reporting

a family tendency to bunions and there may be a genetic predisposition to bunions. Modifiable features such as the wear

of roomy, less pointed more appropriate footwear are important.

It is interesting to note that the condition is rare in populations

who walk unshod. Splints and orthoses are often recommended

but have limited effect on symptoms and do nothing to correct

the deformity. Even after operative intervention a sizable number of patients are unsatisfied with the end result.8

removal of calluses reduces pressure between toes and brings Judiciously applied padding can also relieve pressure and diminish

discomfort. Many of the female afflicted continue to wear tight pointed-toe fashion shoes which continue to confine the forefoot and encourage an on-going problem.

Foot and ankle problems are common medical features

presenting in primary health care. 9. The podiatrist is often first to be approached for a professional opinion and a diagnosis.

Many of these problems can be alleviated by attention to keratotic lesions and appropriate cushioning and padding of foot

and toes. These conditions can be crippling and good foot care

especially in elderly people can ensure they remain mobile and retain a good quality of life and ability to indulge in conventional

and rewarding activities of daily living into advanced old age.

Sadly a considerable number become house-bound due to lesions

of the foot which can be alleviated if not cured by prompt and adequate remedial measures from a podiatrist.

References 1. Garrow AP, Silman AJ, Macfarlane GJ. The Cheshire Foot Pain and Disability Survey:

a population survey assessing prevalence and associations. Pain 2004;110(1-2): 37884

2.Dunn JE, Link CL, Felson DT, et al. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 2004; 159(5): 491-8

3 Hung EHY, Kwok WK, Tong MMP. Haglund syndrome - A characteristic cause of posterior heel pain. Journal of the Hong Kong College of Radiologists 2009; 11(4): 183853

4 Heckman DS, Gluck GS, Parekh SG. Tendon disorders of the foot and ankle, part 2: Achilles tendon disorders. Am J Sports Med 2009;37(6):1223-34.

5 Landorf K, Radford J, Keenan A, Redmond A. Effectiveness of low-Dye taping for the

short-term management of plantar fasciitis. Journal of the American Podiatric Medical Association 2005;95(6):525-30.

6 Landorf K, Keenan AM, Herbert RD. Effectiveness of different types of foot orthoses

for the treatment of plantar fasciitis. Journal of the American Podiatric Medical Association 2004;94:542-49.

7. Owens R, Gougoulias N, Guthrie H, Sakellariou A. Morton’s neuroma: clinical testing and imaging in 76 feet, compared to a control group. Journal of Foot & Ankle Surgery 2011;17(3):197-200.

8 Piqué-Vidal C, Solé M, Antich J. Hallux valgus inheritance: pedigree research in 350

patients with bunion deformity. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 2007;46(3):149.

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 10

HEALTH ARTICLE

Lyme Disease – Explaining the Facts Lyme disease, also known as Lyme borrelisis is an infectious disease caused by the bacterium Borrelia burgodorferi. The disease is classified by the World Health Organisation as an infectious or parasitic disease. Borrelia burgdorferi belongs to the genus Borrelia. Borrelia are members of a larger family of spiral-shaped bacteria called Spirochaetes.

There are many species of Borelia bacteria worldwide, however, not all of them cause disease. At least three species are currently known to cause disease in the UK. They are Borrelia burgdorferi sensu stricto, Borrelia afzelii and Borrelia garinii. They are very closely related and all cause a broadly similar disease process, although different species can be associated with different symptoms e.g. B.garinii with neurological symptoms. Any infection caused by Borrelia bacteria can be termed a ‘borreliosis’.

Early symptoms can include feeling unwell, flu-like symptoms, rash (erythema migrans - EM), headache, stiff neck, muscle pain and increased

sensitivity to temperature, sound and light although symptom patterns vary from person to person. For this reason it is a difficult disease for GP’s to diagnose. Early diagnosis and the administration of antibiotics can prevent the onset of more serious symptoms which can be disabling and difficult to treat.

In the UK, Lyme disease is carried by the sheep tick ( Ixodes ricinus), the hedgehog tick ( I.hexagonus) and the fox tick ( I. canisuga). Ticks are small, blood-sucking arthropods related to spiders, mites and scorpions. There are many different species of tick living in Britain, each preferring to feed on the blood of different animal hosts. If given the opportunity, some of them will feed on human blood too.

There are four stages of the life-cycle: egg, larva, nymph, and adult.

To the naked eye the larvae (with 6 legs) look like specks of soot, while nymphs are slightly larger, pinhead or poppy seed size. With their eight legs, nymphs and adult ticks resemble small spiders. It is the pinhead size nymph which is most likely to bite you.

Once a tick has started to feed, its body will become filled with blood. Adult females can swell to many times their original size. As their blood sacs fill they generally become lighter in colour and can reach the size of a small pea, generally grey in colour. Larvae, nymphs and adult males do not swell so much as they feed. If undisturbed, a tick will feed for around 5 to 7 days before letting go and dropping off.

There are several species of tick in the UK, but the one most likely to bite humans is the sheep tick, Ixodes ricinus. Despite its name, the sheep tick will feed from a wide variety of mammals and birds. The tick bite itself is usually 08 | page

© Photos LDA Copyright

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 11

HEALTH ARTICLE painless and most people will only know they have been bitten if they happen to see a feeding tick attached to them.

When are ticks active?

Cold temperatures reduce tick activity, so ticks are most active from April to October. During warm winters and in certain areas of Britain, ticks ‘quest’ for blood throughout the whole year. Ticks may survive for more than a year without food and their bodies can remain in a dormant state for long periods. Their bodies dry out easily, so lack of moisture can be fatal to them in hot, dry summers Key Facts and in very cold or dry winters.

Where are ticks active?

Ticks can survive in many places but prefer slightly moist, shady areas such as grass, bracken, bushes and leaf litter. This is also where the animals they feed on are most likely to visit. Ticks can be found in both rural and urban locations. They are least likely to be found in areas where conditions are dry.

Do all ticks carry diseases?

There are ‘hotspot’ locations throughout Britain where tick activity has been linked with cases of one or more of the tick-borne diseases. The reality is that we do not know what percentage of ticks are infected in such areas. Even less is known about other areas of the country where ticks may be present in large numbers but the link between ticks and disease symptoms has not been made. For example, not many people realise that Lyme disease is known to be present in central London parks.

Where will a tick bite me?

Many people are unaware that they have been bitten because the ticks are tiny and their bites are

usually painless. Ticks can attach anywhere on your body, so you do need to check all over. For adults it is particularly important to check armpits, groin, navel, neck and head. In addition, on children, ticks are also frequently found on the head at the hairline.

Can I avoid ticks?

It is very difficult to avoid ticks totally because they can be found in urban parks and gardens, as well as typical countryside locations. It is possible for you or your pets to bring ticks into your home.

The best strategy is ‘awareness’.

Check yourself for ticks whenever • disease is an infectious disease caused by you have visited a place where they the bacterium Borrelia burgdorferi. may have been present. Do this both • Lyme disease can be transmitted to humans immediately and for up to three days by the bite of an infected tick. after any outdoor visit.

• Lyme disease has a clinical diagnosis.

• Lyme disease cannot be confidently ruled out by any current test.

• Can be difficult to diagnose

• Lyme disease symptoms overlap with those of many other diseases.

• Early symptoms may include fever, headache, fatigue, and a skin rash called erythema migrans.

• May spread to affect the whole body including eyes, joints, heart and brain.

• If inadequately treated or treated late, may be difficult to cure.

• Lyme disease is treated with antibiotics.

• Lyme disease was named in 1975, after a number of cases occurred in Old Lyme, Connecticut, USA.

• Lyme disease is not a new disease, it was known in Europe under different names in the early 20th century and was carried by Neolithic “Ötzi the Iceman”.

• Lyme disease is not spelt Lymes disease, Limes disease or Lime disease.

• Lyme disease may also be called Lyme borreliosis.

• Lyme disease-carrying ticks can be found in urban parks and gardens as well as in the countryside.

This may allow you to see any adult tick that has attached. Once it has started to feed, it’s blood engorged body will make it very visible. If you find a tick, remove it as soon as possible.

Ticks can locate their prey by detecting host body heat, carbon dioxide and ammonia. They may crawl towards a stationary host or stretch out their front legs, equipped with tiny ‘grappling hooks’ in order to attach to a passing host. So anything you can do to thwart these tactics may help you to avoid tick bites.

There are many suggestions about how to stop ticks reaching your skin but there has been little measurement of their effectiveness.

Lyme disease is not an easy diagnosis to make and there is no diagnostic test that is absolutely reliable. Awareness still remains the best strategy and sensible measures taken to avoid being bitten when walking in the countryside especially.

The following suggestions will all page | 09

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 12

HEALTH ARTICLE help to reduce the risk of being bitten.

• You should make it more difficult for a tick to reach your skin by wearing shoes rather than sandals and tuck long trousers into socks.

• Ticks can be more easily seen on white or light-coloured clothing.

• Avoid a tick’s favourite places by walking in the middle of paths and check yourself after sitting on logs or leaning against tree trunks.

• Use a light coloured blanket for picnics, it is then easier to check for ticks.

• Check your pets for ticks when they come into the house and especially keep them off bedding and soft furnishings.

Consider using anti-tick pesticides for pets, please consult your veterinary surgeon for advice.

• Consider spraying your clothing with an effective anti-tick pesticide. There are a variety in outdoor shops and chemists. Make sure you follow the instructions carefully.

The Institute would like to thank ‘Lyme Disease Action’ for their help in compiling this article. More information can be obtained from their website www.lymediseasaction.org.uk.

About Lyme Disease Action (LDA)

Lyme Disease Action exists to address the current lack of awareness of Lyme disease amongst the public and the medical profession.

The Public is often unaware that ticks can carry disease. Patients may ignore a rash and being unaware of the significance of some symptoms, do not relate them to their GP. Thus easily diagnosed early Lyme disease can become very difficult-to-diagnose late and chronic Lyme disease.

Doctors often believe that Lyme does not exist in their area, they do not recognise the rash and they are unaware of the wide variation of symptoms that can affect almost every part of the body. In early 2013, following a James Lind Alliance project, we published a list of verified uncertainties in the treatment and diagnosis of Lyme disease. Our task now is to spread this to medical professionals who may believe that diagnosis and treatment is straightforward.

We are also working with Researchers through the National Institute for Health Research and other bodies to ensure that these known uncertainties are taken up as topics for research.

2012 saw a shift in national policy and the Department of Health and Public Health England are now working with LDA to improve awareness and tackle the uncertainties.

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 13

DIABETES NEWS

Home use of artificial pancreas creates historic diabetes landmark

Five adults with Type 1 diabetes have played a landmark role in the history of diabetes research by becoming the first adults to use an artificial pancreas in their homes without medical supervision.

This step offers real hope for a future where people with Type 1 diabetes no longer have to monitor blood glucose levels, and where they have a better chance of living a long and healthy life.

The artificial pancreas is a "closed loop" system that monitors blood glucose levels and uses this information to adjust the amount of insulin being administered by an insulin pump. This ensures that the person is always getting the right amount.

The idea for this system has been talked about for a long time, but researchers have had to proceed cautiously: having too much or too little insulin is potentially harmful, so malfunctions with the technology had to be avoided. But in 2011 researchers completed a trial where people with Type 1 diabetes used the artificial pancreas in a hospital setting, which cleared the way for a new trial of the prototype device at home.

The research, led by Dr Roman Hovorka, began recruiting participants for the trial at the end of last year. Now five participants have spent four weeks using the artificial pancreas at night, which is a time when blood glucose levels can fall too low. In total, 24 people will take part in the trial and will use the artificial pancreas at night for four weeks, while using standard therapy for another four weeks. The results of the trial are expected to be ready by the end of the year.

Even if the results are promising, it will take some time before the artificial pancreas becomes available as a treatment for Type 1 diabetes, and initially it would probably be used just to stop people’s blood glucose levels from falling too low at night.

However, it is thought that within a decade the technology could develop to a point where those who use it no longer have to monitor their blood glucose levels.

As well as being more convenient, the artificial pancreas could help people with diabetes to keep much tighter control of their blood glucose levels than is possible with current methods.

Having consistently high blood glucose levels puts people at increased risk of health complications such as amputation, kidney failure and stroke, and is the main reason why, on average, people with Type 1 diabetes die about 20 years younger than the rest of the population. This means that, in the long term, the artificial pancreas has the potential to significantly reduce the number of premature deaths related to the condition.

Dr Alasdair Rankin, Director of Research for Diabetes UK, said, "After years of scientists discussing the possibility of an artificial pancreas, we are now finally at the exciting point where people are using them in their homes. This means we have reached a landmark in the development of a technology that offers real hope for a future where Type 1 diabetes does not mean having to think constantly about the balance of blood glucose and insulin or having to face a much higher risk of dying early.

"We don’t want to give people false hope that an end to the management of Type 1 diabetes is just around the corner. It is still early days, and even if this trial shows that the artificial pancreas can be used safely and effectively in people’s homes, there will need to be bigger trials before it can be offered as a routine treatment. But I think we are talking years rather than decades before this becomes a reality.

"Also, it is likely that the device would initially be used only at night and so, while important for blood glucose control, the people using it would not notice an immediate difference in their daily lives. However, as the technology progresses, we expect it to make Type 1 diabetes an increasingly manageable condition until eventually we will reach the point where people might check their artificial pancreas when they get up in the morning and then do not have to think about their diabetes for the rest of the day.

"The five participants who have spent four weeks using the artificial pancreas in their home are pioneers at the cutting edge of Type 1 diabetes research, as we expect thousands more people to follow in their footsteps in the years to come."

Dr Roman Hovorka said, "The artificial pancreas has the potential to significantly improve the lives of people with Type 1 diabetes, by revolutionising blood glucose control at home and by lowering their risk of an overnight hypo. We’re excited to be making progress with this research and look forward to bringing this important device one step closer to the clinic." Dr Rankin added, "We are delighted to be announcing this development at the beginning of Diabetes Week, in particular, because the theme this year is how scientific research can make a real difference for people living with diabetes and those at risk. There is no better example of that working in practice than how the artificial pancreas promises to transform the lives of people with Type 1 diabetes within a generation." (further information www.diabetes.org.uk)

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 14

OBITUARY

FRANCIS ROLAND HALE 1914 – 2013 Dear Editor,

As you all know, Ron practiced chiropody for more than sixtyfive years and he was treasurer and secretary of the Tees-side branch of the Institute of Chiropodists and Podiatrists for most of those years.

Until the last few years we held our branch meeting at Ron's home on Grange Road, Darlington. We all looked forward to these meetings not least for the delicious refreshments provided

by Gina, Ron's charming wife.

In addition to operating a successful and busy Chiropody and Physiotherapy Practice for many years (he was still treating patients well into his eighties), Ron was active in the Institute at all levels. Tees-side Branch was founded in 1948 and Ron was an active member right from the start. He was Treasurer from 1952 then Secretary/Treasurer from 1958 until 2000. Looking back in the Branch Accounts Book that he so meticulously maintained we see that in his early years he was writing 30-40 letters a year (by hand) on behalf of the Branch! This was on top of his working day and long before word processors or computers arrived on the scene. In those days the cost was recorded at two and a half (old) pence per letter!

Towards the end of his tenure as Secretary/Treasurer he tried several times to step down and hand over the reins to somebody younger but branch members kept on re-electing him for several more years! We all felt that he was irreplaceable...and he was.

However, Ron was never a person to occupy a pedestal. If there were any contentious issues at Branch meetings he was always willing to listen to the views of others, though in the end, more often than not, we had to agree that Ron was usually right all along!

Ron's knowledge of our profession and especially matters relating to the Institute was legendary. He had an encyclopaedic memory for names and dates of events that had sometimes taken place many years before. He seemed to know the Institutes Articles of Association and Bye-Laws off by heart!

He very much encouraged the younger generation of Practitioners coming through the ranks as some of us can personally testify to, and he was a strong advocate of members furthering their own education and qualifications. Indeed, he was an early pioneer of what we now call Continual Professional Development.

As we know, Ron was approaching his 99th birthday but his mind was as sharp as ever. We all have our own special memories

12 | page

of Ron that we will cherish for many a year to come.

Tees-side Branch has lost our most distinguished and long standing member. The world has lost a true gentleman in every sense of that word.

He was our friend and our mentor and we will miss his guidance, his warmth and his sense of humour.

May you Rest in Peace Ron.

Catherine O’Donnell, Tees-side Branch

Dear Editor,

I was most saddened to receive a telephone call informing me of the death of my old friend and comrade, Francis Roland Hale, known to all simply as ‘Ron’.

I was Chairman of the Executive Committee and Ron was ViceChairman at the same time. Ron loved the Institute and was a member for over 50 years, 25 as a serving member on the Board of Directors. He worked tirelessly for the good of our association.

His professional knowledge combined with his no nonsense approach and amazing memory made him a perfect leader.

Sadly we did not keep in touch after our ‘reign’ was over, but I have many fond memories. Rest in peace Ron. Stanley Harrison Chairman, Executive Committee 1980 - 1983 President 1985 – 1991

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 15

OBITUARY Dear Editor,

It was with sadness that I learnt of the death of a stalwart of the Institute, who had reached his ninety ninth year.

Known as Ron, he was a fixture of the Institutes’ Executive Committee holding the post of Vice-Chairman and Chairman of the Standing Orders Committee well before I became its Minute Secretary and then its Secretary and before my late husband Jim, became its Accountant.

Ron was a mine of information on the Memorandum and Articles of Association and Bye-Laws and procedure at the AGM and Standing Orders Committee over which he presided with meticulous attention to detail. He was a stickler for protocol and the correct interpretation of the rules and was very helpful to us both when the Institutes’ Head Office transferred to Southport following the retirement of the then Secretary, Sidney George Shipper, with whom Ron had a good friendship.

We kept in touch over the years and had a long conversation with him when his lovely wife Gena died some years ago. In his last Christmas card, he wrote “Happy Memories, Love Ron” and that is how I will remember him.

My sincere condolences go to the neighbours of whom Heidi Varley is one, who adopted Ron and Gena as honorary grandparents a long time ago and who looked after them both for many years and were with him when he died on 13th April.

Susan Kirkham Former Secretary of The Institute of Chiropodists and Podiatrists Dear Editor,

I first met Ron in 1967 at an Institute conference at the Cliffs Hotel Blackpool, Lancashire. I had newly joined the Institute and Ron was very kind to me. He had lost his first wife but found happiness with Gina, his second wife.

Ron was great friends with my mentor Harold Laskey and his wife Esther. Harold was Treasurer and Ron was Chairman of Standing Orders Committee. Nobody, but nobody knew the rules of the Institute better than Ron. I think he ate, slept and drank them. I often remember him getting up at Conference and saying ‘you can’t do that because page 7 bye law 32 sub section 3 says etc etc. He was an Institute man through and through. When Harold stood for president I remember Ron saying ‘I won’t stand against Harold.’ Ron was a physiotherapist as well as a chiropodist and he thought that the Institute should have a chiropodist alone as its president.

Ron had a Jaguar car and Gina had a Mini. Ron would do all the servicing of the cars himself. He was a very practical man. He had a full and active life and died in his late 90s.

Goodbye old friend, you were kind to me. He was a very straight person as he used to ‘Rules is Rules.’ You always knew where you were with Ron. Roger Henry Chairman of Devon and Cornwall branch.

Dear Editor,

I was saddened to hear of the death of Ron Hale at the age of 98.

Ron from Darlington had been a member of the Royal Army Medical Corps during the war, it is more than likely that Ron had undertaken chiropody training as part of the RAMC structure, as this was something that was offered in the army at this time, bearing in mind that State Registration did not come into force until the 1960's.

Ron also at some stage qualified as a Physiotherapist and after the war opened his chiropody practice in Darlington undertaking visits and general Chiropody services, along with Physiotherapy treatment.

Ron was a staunch member of the Institute for over 50 years and was Vice Chairman of the Executive for 25years, his knowledge of our Rules and Regulations was second to none, and I was privileged to have taken over from him as Vice Chairman a few years ago.

Ron is one of the last of the Institute’s founding fathers, so thank you Ron for all you have done for the Institute.

Our thoughts go to his family.

David Crew Surrey and Berkshire Branch Dear Editor,

I cannot add much more to what others have said and I did not know Ron very well. However, when I first joined the Institute of Chiropodists and Podiatrists he was legendary and frequently quoted by others.

I remember he was often phoned with questions regarding our rules and regulations because, at the risk of repeating what has already been said, he knew them by heart and would give instant responses. There was no “I will get back to you on that one” for Ron. He knew exactly what the score was!

I often heard people singing his praises at conference but by the time I took office he had long since retired. I would have liked to have had the opportunity to work alongside this great man.

My condolences to his family.

Stephen Willey Ex Chairman, Board of Ethics.

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 16

AWARENESS DAY

Increasing your protection for the silent infection World Hepatitis Day - 28 July 2013 This year will be the sixth annual World Hepatitis Day - taking place on 28 July, on the same date as the birthday of Nobel Laureate Professor Blumberg who discovered Hepatitis B. The whole point of the day is to encourage people to find out the facts about Hepatitis A, Hepatitis B and Hepatitis C - and by doing this help decrease the stigmas attached to the viruses.

The name Hepatitis means liver inflammation in Greek.

Hepatitis A is a type of viral liver infection uncommon in England but widespread in other parts of the world such as Africa and India.

Initial symptoms of hepatitis A are similar to flu and include:

• low grade fever – usually no higher than 39.5C (103.1F) • joint pain

• feeling and being sick

This may then be followed by symptoms related to the liver becoming infected, such as: • yellowing of the skin and eyes (jaundice)

• passing very dark coloured urine and • pale faeces (stools or ‘poo’) • abdominal pain • itchy skin

In most cases the liver will make a full recovery.

Hepatitis C has been referred to as the 'silent epidemic'. That's because where some people will have symptoms straight away others could go up to ten years without knowing anything is wrong. Thankfully drug treatments have been successful: 50% success for genotype 1 and an even better 80% for genotype 2, but there is still no vaccine and it's important people are more in the know about exactly how dangerous hepatitis is and what it does.

14 | page

Treatment involves three consecutive injections over a three or six month period. Following this a blood test is taken to check effectiveness.

This year the World Hepatitis Day is taking place on the birthday of Nobel Laureate, Professor Blumberg who discovered Hepatitis B

Symptoms usually clear up within two months, although occasionally last up to six months. Older adults tend to have more severe symptoms.

Hepatitis B

blood from an infected person either by transfusion or by sharing contaminated needles e.g. drug addicts or tattooists etc, by sexual contact with an infected person and it can be passed to unborn children by infected mothers. It is highly infectious.

The incubation period is from two to six months from the time of exposure to the virus until the onset of the disease. Early symptoms include poor appetite, nausea, aching muscles and joints and sometimes mild fever. Later symptoms include yellowing of the skin, mucous membranes, and whites of the eyes (jaundice, icterus); light-coloured stools; and dark urine.

is caused by a virus and is spread by contact with

When the late symptoms have developed, the patient usually begins to get better.

In approximately 1 out of 20 infected adults, the infection becomes chronic or on-going. Patients with chronic hepatitis B generally have no symptoms unless they develop liver damage.

Approximately one fifth of those with chronic infection develop scarring of the liver (cirrhosis) over a number of years which may result in liver failure and risks of liver cancer.

On average, cirrhosis develops decades after infection. Infected newborn babies may show no symptoms of acute hepatitis but unless given appropriate immunisation have high (more than 90 per cent) risks of chronic infection.

How can type B hepatitis be prevented?

• Avoid sharing needles and syringes with others.

• Avoid sharing razors and toothbrushes with infected people.

• Practise safer sex with condoms.

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 17

AWARENESS DAY • Use a condom during sexual intercourse.

• Vaccination, which is very effective against type B hepatitis, is available and three doses are recommended.

The second and third doses are given one and six months after the first dose. Alternatively, for faster initial protection, the second and third doses can be given one and two months after the first dose, with a fourth dose then needed at 12 months.

• In some countries HBV vaccination is part of the routine immunisation schedule. Other countries have opted for vaccination for high risk groups.

The vaccine is recommended for the following groups: • family members of people with hepatitis B • sexual partners of people with hepatitis B • newborn babies whose mothers are infected with hepatitis B virus • drug users • homosexual men • hospital staff that frequently come into contact with blood.

What can be done at home?

• Be careful to protect your family and sexual partners from the virus.

• Abstain from all alcohol intake if blood samples show that the disease is active.

• If you have chronic hepatitis, you should be reviewed regularly in a specialist clinic because there are several treatment options • Eat a healthy, well-balanced diet.

How is hepatitis B diagnosed?

The diagnosis is made on the basis of a blood sample which will demonstrate antibodies against hepatitis B, or hepatitis B components in the patient's blood.

The blood sample can demonstrate the presence of several different viral components. All patients with chronic infections have the viral component called hepatitis B surface antigen (HBsAg). HBsAg is a marker for the presence of the virus in the blood.

A blood test for liver function can determine the severity of the

disease – the extent to which the liver has been damaged by the virus. In cases of chronic hepatitis B, the severity of the disease can be determined by obtaining a tissue sample (biopsy) from the liver.

Future prospects

Most patients with acute hepatitis B fully recover in about four to six weeks. Very few patients develop liver failure as a result of acute hepatitis, and risk a fatal outcome.

The infection becomes chronic in 1 in 20 adult patients. However, the number is much higher in cases of newborn babies who have contracted the virus from their mothers. The most serious complications of chronic hepatitis B are cirrhosis, and, in rare cases, liver cancer.

Professor Blumberg

Baruch Samuel Blumberg known as Barry was born on the 28th July 1925 in Brooklyn, New York to Meyer and Ida Blumberg.

His elementary years were spent learning Hebrew and studying the Bible and Jewish texts in their original language. He later attended Far Rockaway High School in Queens.

During World War 2, Barry served in the U.S. Navy before graduating with honors in 1946 at the Union College in Schenectady, New York.

In 1951, he received an MD from Columbia University’s College of Physicians and Surgeons and began graduate work in biochemistry at Balliol College, Oxford where he became the first American to be a ‘Master’.

In 1976 Barry was the co-recipient of the Nobel Prize for “discoveries concerning new mechanisms for the origin and dissemination of infectious diseases”. He identified the Hepatitis B virus and developed its vaccine. In 2002 he published Hepatitis B: The Hunt for a Killer Virus, an account of the discovery for which he won the Nobel Prize.

In 2005 he became the President of the American Philosophical Society – a post he held until his death in 2011.

One of the many tributes was from Jonathan Chernoff, scientific director, Fox Chase Cancer centre who stated that “"I think it’s fair to say that Barry prevented more cancer deaths than any person who’s ever lived."

Refs: http://en.wikipedia.org,

Further information http://www.hepctrust.org.uk/ and

http://www.netdoctor.co.uk/diseases/facts/hepatitisb.htm#ixzz2SsmlSGu2

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41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 18

HEALTH ARTICLE

Miracle foods: a special report from ‘Behind the Headlines’

Analysing food studies in the media “Curry could save your life.” “Beetroot can fight dementia.”

“Asthma risk linked to burgers.” Every day there’s a new crop of seemingly life-changing headlines about how the food we eat affects our health.

We all know that a good diet is an essential part of a healthy lifestyle, so it’s not surprising that newspapers, magazines and the internet are full of stories about miracle superfoods and killer snacks.

Of course, there’s more to it than that. There’s a vast industry devoted to finding new ways to persuade us to eat this or that food and an army of scientists bent on exploring the links between what we eat and how healthy we feel.

Unfortunately, much of what is reported can be either inaccurate or unhelpful. The news is full of contradictory reports and often the same food is declared healthy one day and harmful the next.

Take alcohol. Sometimes it’s reported to be good for your health, while other times it’s bad. Some days we’re told to drink in moderation, while on others even a single glass is too much.

The facts about the latest dietary discoveries are rarely as simple as the headlines imply. Accurately testing how any one element of our diet may affect our health is fiendishly difficult.

And this means scientists’ conclusions, and media reports of them, should routinely be taken with a pinch of salt.

That’s where Behind the Headlines fits in. For the past three years, we have reviewed health science stories in the media and checked the reported claims against the research on which they are based.

Food stories are one of the most frequently occurring topics that Behind the Headlines covers, featuring in about a fifth of the 1,750 appraisals since mid 2007.

A quick analysis shows just how confusing these stories can be.

Of the 1,750 Behind the Headlines appraisals carried out up to January 18 2011, based on stories in the national press, 344 were about foods that had repercussions for health. We analysed those that reported on a single food or drink, grouping them into 106 single foodstuffs. Categorising these stories into whether the food was reported to be good for health or harmful gives a crude yet revealing indication of how food science is portrayed in the press.

16 | page

As shown in the diagram overleaf, although some stories highlight the potential harms of particular foods, most proclaim benefits.

When grouped as foodstuffs, 27 foods had been labelled harmful by headline writers, while 65 had been declared beneficial. Fourteen, however, have been labelled both healthy and harmful in different headlines. Chocolate, for example, can reportedly cause weak bones and depression, but other studies have claimed that it can also help fight cancer.

How foods have been reported in the media 65 foods were good for health

examples are:-

bitter melon, blackcurrant, chillies, fruit, passion fruit, pomegranate, purple fruit, purple tomatoes, rosehip tomatoes, beetroot, broccoli, sprouts, carrots, cauliflower, celery, garlic, ginger, mushrooms, onions, spinach, whole cooked carrots, dairy organic milk, skimmed milk, yoghurt, caveman diet, fatty food, low-fat diet, Mediterranean diet, veganism, whole cooked carrots, champagne, red wine, beetroot juice, black tea, cherry juice, green tea, hot drinks, mint tea, tomato juice, bacon and eggs, breakfast cereal, fry-ups, meat and potatoes, porridge, chewing gum, curcumin, gummy bears, honey, jam, ketchup, marmite, olive oil, peanut butter, popcorn, turmeric, almonds, nuts, rice, wholegrains, cod liver oil, fibre probiotics, protein.

14 foods were both good and bad for health Eggs, bacon, alcohol, grapefruit, low carb diet, vegetarianism, beer, white wine, hot tea, chocolate, nut products, caffeine, fish oils, salt.

27 foods were bad for health 5 a day high carb diet, organic food, Western diet, burgers (three a week), chicken, processed meat, red meat, sausages, coffee, energy drink, fruit juice, sugary drinks, water, fast food, packed lunch, pre-packed sandwiches, takeaways, cake, chewing gum, soya-based food, sweets, unsoaked potato chips, nut products, fructose, polyunsaturates, sweeteners.

Based on UK national press reports analysed by Behind the Headlines between July 2007 and January 2011.

So more than half of the articles discussing a foodstuff focus on some sort of benefit.

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 19

HEALTH ARTICLE But what really seems to capture the imagination of journalists and consumers is the idea that a single food, sometimes called a superfood, can confer remarkable health benefits. There is no official definition of a superfood and the EU has banned the use of the word on product packaging unless the claim is backed up by convincing research. A number of well-known brands have been forced to drop the description. However, there are still some proponents of the term, in spite of its loose definition.

foods on our health is notoriously tricky to carry out. We have complex diets and it is difficult to disentangle the effects of one particular food or compound from all of the others we consume.

This means that many of the studies behind the superfood claims have limitations. These limitations are rarely reported in the media, and even more rarely given their true significance. Some of these limitations are discussed below. Knowing about them will help you to sort science fact from news fiction.

News headlines, meanwhile, abound with claims that certain foods have super health benefits. Celery, broccoli, jam, popcorn and cereals have all been hyped as superfoods in the past couple of years. Other foods are said to be packed with chemicals that can ward off major killers such as cancer and heart disease.

Confounding is a common problem in health research.

Confounding is where something other than the main factor that is being assessed (a confounding factor) may be responsible for effects.

Wine, for example, can allegedly: • “add five years to your life” • “help keep teeth healthy” • “protect your eyes” • make women “less likely to gain weight” While broccoli can allegedly “undo diabetes damage”, “stop breast cancer spreading” and “protect the lungs”.

Even our beloved cuppa has been given superfood status. Black tea has been alleged to protect against heart disease. Green tea can supposedly cut the risk of prostate cancer. And it has been claimed that camomile can keep diabetes under control.

Miracle claims are also made for chocolate, including that a daily bar “can cut the risk of heart attack and stroke”.

It’s not uncommon for headlines to claim the most miraculous health benefit of all – that a food can save your life. The following are all genuine claims from UK media from the past two years: • “2½ bottles of wine a week can save your life” • “A daily dose of garlic can save your life” • “Just one bite of chocolate a day can help save your life” • “Beetroot juice could save your life” • “Curry could save your life” You could be forgiven for thinking the secret of eternal life is a daily vindaloo, washed down with a glass of wine or two and a chocolate dessert.

Of course, the truth is that these claims are almost always overstated. Unfortunately, research into the effects of single

Take the story about half a glass of wine a day adding five years to your life. The results of this study of 1,373 Dutch men who were followed for over 40 years certainly sounded promising. The study found that men who consumed an average of about half a small glass of either red or white wine a day lived about five years longer than those who didn’t drink alcohol. It also found a lower risk of death from cardiovascular disease among those who drank a small amount of wine compared with teetotallers.

In humans, this type of study, called a cohort study, is often used to find out more about diet and health. Cohort studies enable researchers to follow large groups of people for many years to find out if a specific food or supplement is associated with a particular health outcome. A long follow-up period is particularly important when researchers are looking at the relationship between diet and outcomes such as cancer and heart disease.

The difficulty is that there are many things that can affect how long we might live or whether we’re at risk of cardiovascular disease. They probably include, for example, social status, physical activity, body mass index (BMI) and the overall quality of our diet. Therefore, if the groups being compared (in this study those who drank a small amount of wine and teetotallers) differ in any of these other factors this could be contributing to the differences in lifespan, rather than just wine consumption.

Researchers call things that can affect the results of a study in this way confounders, and the best cohort studies adjust their findings to take into account as many confounders as possible.

The wine study, for example, adjusted its findings for several possible confounders, such as smoking status, BMI, medical history and socioeconomic status. Surprisingly, however, it didn’t adjust for how much physical activity the men did. If more wine drinkers than teetotallers exercised regularly, then this could be why the former lived longer than the latter.

A study that suggested that green tea could reduce the likelihood of developing prostate cancer had a similar weakness.

It found that men who drank five cups of green tea a day were page | 17

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HEALTH ARTICLE about half as likely to develop advanced prostate cancer as those who drank only one cup. This study involved nearly 66,000 men in Japan, who were followed for 14 years. It was a study with a large number of participants and a long follow-up, both of which are strengths. But it’s possible that men who drink lots of green tea are also more likely to adhere to a traditional Japanese diet.

This means diet may be a confounding factor. In fact, this is partly what the researchers found – that men who drank more green tea also ate more miso and soy, as well as fruit and vegetables.

They also differed in other ways from men who drank less green tea. So it’s difficult to say for certain whether the green tea is responsible for the lower risk of cancer or whether other elements in the diet were involved.

Often, studies measure outcomes that aren’t directly relevant to people’s health. Instead, they choose a proxy, which is something that is easier to test and which may be an indicator of a health benefit. The trouble is that media reports often confuse these proxy measures with the real thing.

Let’s look at an example. A claim that omega-3 fats may be an “elixir of youth” was based on research in heart patients that didn’t look primarily at patients’ health, but at the length of telomeres, which are regions of DNA at the ends of chromosomes. Telomeres shorten each time a cell divides, so telomere length is often used as a proxy measure for (an indicator of) biological ageing.

Many studies looking at foods rely on people being able to recall what they have been eating and drinking in some detail, sometimes several months or more in the past. Recall bias is an important problem. Do you remember how many eggs you ate last year? Do you think your memory of those eggs would be affected if you found out you had high cholesterol? In the Dutch study of alcohol and mortality mentioned above, men were asked to recall how much they were eating and drinking up to a year ago. This is not unusual in studies of food. Estimating how much alcohol a person has consumed is especially tricky as the alcohol content varies between drinks. There are many reasons why people may look back with rose-tinted spectacles (and rosy cheeks) at their alcohol consumption and may underestimate the amount they consumed. Some may do this deliberately because they don’t want to look bad when they complete their questionnaire.

Recall bias wouldn’t be such a problem if it affected all people in a study equally, but often those with a particular outcome will remember their consumption differently from those who don’t have that outcome. The eggs/high cholesterol example above is one, but the same may happen to people with food poisoning.

People who have had food poisoning are much more likely to remember the evening out and the funny tasting curry than someone who didn’t get ill. This inconsistency in recall depending on the outcome leads to bias in studies.

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Additionally, what we eat and drink can vary from day to day and from year to year. So, if we are asked about our current eating habits, our answers may not be representative of what we have eaten throughout the rest of our lives. Food questionnaires often also ask about how many portions or cups of certain foods are eaten per week, and people may have different ideas about portion or cup sizes.

The study found that people with higher omega-3 levels in their blood also had less shortening of their telomeres. That’s interesting, but it tells us nothing about whether omega-3 fats had any impact on the patients’ health or on the cardiovascular disease process.

Similarly, one study that reportedly showed that oily fish could reduce memory loss did not measure people’s memory. It scanned people’s brains for areas starved of oxygen (called infarcts) and other abnormalities, to find out if there was any association between fish consumption and brain changes.

Eating fish three times a week was associated with a nonstatistically significant reduction in risk of these brain abnormalities. Even if the difference had been significant, the study could not say whether oily fish prevents memory loss, as memory was not measured. Only a trial that directly measures people’s memory can tell us about the link between oily fish and memory.

Using a study in humans to link an indirect outcome measure to a disease is one thing, but many of the health stories reported in the press have not been carried out in people at all. Animal and laboratory studies are often used to test what researchers suspect to be the active components of foods, which might in time be developed into drug treatments or supplements. There’s been a lot of excitement, for example, about resveratrol, a compound found in red wine that has been shown to extend the life of yeasts, roundworms, fruit flies and also obese mice fed a high-calorie diet. Studies of this compound have suggested that resveratrol may cause cellular changes that have a positive effect on age-related processes, and may possibly have other benefits.

However, the doses of resveratrol used in lab studies may bear no relation to how much resveratrol humans can realistically get from drinking red wine. In one study, which found resveratrol helped stop abnormal growth of blood vessels in the eyes of mice, the human equivalent of the dose given would be several bottles of wine a day.

Before you reach for the resveratrol supplements (which do exist), bear in mind that just because this compound was associated with cellular changes in mice and some invertebrates, that doesn’t mean it will have the same effect in humans. Animal studies are a valuable first step in finding out more about the active ingredients in a food or drink, but we need to wait for the

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HEALTH ARTICLE results of clinical trials to find out if the same results hold true for humans.

Studies on cells or tissues in the laboratory may give useful clues to a food’s properties, but they are often overinterpreted by the media. There is often a long way to go before we know whether lab findings could be relevant to humans eating food in real-life situations.

In one lab study that inspired the headline “Broccoli may undo diabetes damage”, researchers applied sulforaphane, a compound found in broccoli, to human blood vessels incubated with sugar. Their aim was to find out whether sulforaphane could prevent damage to small blood vessels caused by high blood sugar (which can happen if you have diabetes). They found that sulforaphane did seem to protect cells from potentially damaging chemicals. This is an interesting finding, but a far cry from the claims of the news headline.

In another study, sulforaphane was applied to human breast cancer and mouse cancer cells in the laboratory and injected into mice with mammary gland tumours. The results suggested that the compound may be able to target cancer stem cells and stop them from dividing as much. This finding is promising and certainly warrants further research, but it would be misleading, possibly dangerous, to assume it means that eating broccoli can stop cancer in its tracks.

Sometimes it’s not newspapers that are at fault in misinterpreting these kinds of studies, but researchers and press officers anxious to garner publicity. One study found that broccoli improved heart muscle function in rats whose hearts had been removed and subjected to a simulated heart attack. The title of the study called broccoli a “unique vegetable”, when it is unknown if other vegetables might have the same result. It also implied that the results could apply to mammals generally, when that remains to be seen.

Sometimes, a suggested association between a food and a health outcome looks doubtful on the basis of common sense. In such cases we have to ask ourselves whether the association seems plausible. For instance, in the study linking chocolate consumption to better cardiovascular health, people who ate the most chocolate had a 39% lowered risk of heart attack or stroke compared with those who ate the least chocolate. However, the difference in consumption between those who ate the most and those who ate the least chocolate was minimal: less than one small square (5g) of a 100g bar. Common sense tells us that this difference is unlikely to account for a 39% reduction in cardiovascular risk. The idea that helping yourself to a bar of chocolate a day will stop you having a heart attack or stroke may sound attractive, but this research does not provide any basis for it.

It’s important to know the source of funding in food studies, as

with drug studies. One study that claimed chocolate lowered stress levels involved only 30 healthy young adults and had numerous flaws, including a very short follow-up period (14 days).

It was also funded by a large chocolate manufacturer. But just because a study is funded by the food industry doesn’t necessarily mean it will be of poor quality. However, there may be a vested interest in giving a positive spin to results or getting it into the newspapers for a little publicity.

Generally, the best type of study for finding out if a food has any effect is a randomised controlled trial (RCT). RCTs can avoid some of the problems of other studies and there is usually more confidence in their results. In RCTs, participants are assigned randomly to different groups to decide which intervention (in food studies, which diet or dietary supplement) they will receive.

This is the best way to generate groups that are balanced for known and unknown factors that could affect the results. A control group that is not exposed to the intervention is used as a comparison. This means that any differences seen between the groups can be attributed to the differences in diet or dietary supplement used.

RCTs are not always feasible for looking at the long-term health effects of a specific food. RCTs are expensive and people may not be willing to alter their diet for an extended period. Therefore, the randomised trials that are performed usually measure the results of short-term consumption of a food or test the active component of a food taken as supplement.

Interestingly, one randomised trial that looked at fish oil and cognitive function in 867 elderly people, found no significant difference in cognitive function between fish oil supplements and placebo. There’s been much excitement surrounding the possible effect of fish oils on cognitive function, yet this study, one of the few RCTs looking at this area, came up with negative results. This may be because this is a better quality study, but it also lasted only two years, which, as the researchers say, may have been too short a period to detect any effect.

By now you may well be despairing of any research ever being able to prove anything about our diet or about so-called superfoods. Finding out about the effects of particular foods on health is a bit like doing a jigsaw. It’s a gradual and painstaking process in which, by conducting different types of studies, researchers gradually fit together the pieces so that a tentative picture begins to emerge.

The best way to get a look at this overall picture is by looking at what systematic reviews have to say about diet and health.

Systematic reviews take the best quality available data from individual studies and see how the evidence stacks up. By looking carefully at all the research, systematic reviews can give an accurate picture of the state of the evidence so far and are, therefore, more reliable than looking at a single study in isolation. page | 19

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HEALTH ARTICLE It would be a huge undertaking to carry out a comprehensive review of all the studies investigating the potential health properties of food. But, here’s what systematic reviews (considered to be the strongest type of evidence) have found up to the end of 2010.

A systematic review by the World Cancer Research Fund (WCRF) in 2007 concluded that alcohol consumption is associated with an increased risk of some cancers, with apparently similar effects for different types of alcoholic drinks. Their recommendation was that alcohol consumption should be limited, even taking into account the likely link between moderate alcohol consumption and reduced risk of heart disease. In the UK, current guidance from the NHS recommends avoiding binge drinking and for women to consume no more than 2-3 units a day, and men no more than 3-4 units a day on a regular basis.

Eating more non-starchy vegetables, such as broccoli, is associated with a reduced risk of cancer according to the WCRF systematic review on cancer prevention (see above). It is possible that some of the compounds in broccoli may have health benefits, but clinical trials are needed to investigate this.

A Cochrane systematic review from 2006 found that at that point there was no evidence from RCTs about whether omega-3 fats (thought to be one of the “active ingredients” in oily fish) could reduce the risk of cognitive impairment or dementia. As we mentioned earlier, a subsequent placebo-controlled RCT has found that a daily fish oil supplement given for two years did not improve cognitive function in cognitively healthy older adults.

This single RCT does not rule out the possibility that longer-term supplementation might affect cognitive performance or help those who are already cognitively impaired, but it does suggest that the effects of omega-3 fats on cognitive performance are not clear-cut.

Systematic reviews of RCTs in The American Journal of Clinical Nutrition, Archives of Internal Medicine and Nature have found that cocoa or chocolate can reduce blood pressure. However, they identified no RCTs looking at the effects on important clinical outcomes such as cardiovascular disease or mortality. Chocolate of any variety is high in fat, sugar and calories and, if eaten to excess, is likely to increase the risk of obesity, heart disease and diabetes. Whether any potential benefits of eating a moderate amount of chocolate can outweigh the potential harms remains to be seen.

There’s also good evidence supporting the health benefits of a Mediterranean-style diet. The Mediterranean diet is high in fish, olive oil and fruit and vegetables, while containing relatively little meat. One systematic review, published in the British Medical Journal, shows that this type of diet can reduce the risk of some chronic diseases and increase the chance of living to a healthy old age.

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One systematic review we covered in 2008 found that there was evidence from observational studies that eating oily fish two or more times a week reduced the risk of age-related macular degeneration, a common cause of blindness in older people.

However, the review suggested that this should be interpreted cautiously due to weaknesses in the underlying studies.

As yet, green tea cannot be recommended to stave off cancer because, according to a Cochrane systematic review from 2009, the evidence from studies is “highly contradictory”. It appears to be safe in moderate amounts, so lovers of green tea can continue to enjoy it.

You will have gathered by now that there’s no real evidence that superfoods exist, if by that we mean a single food or compound that will keep us healthy, stop illness in its tracks or save our life.

When it comes to keeping healthy, it’s best not to concentrate on any one food in the hope it will work miracles. Current advice is to eat a balanced diet with a range of foods, to ensure you get enough of the nutrients your body needs. Limiting your intake of alcohol and high fat, high sugar, salty and processed foods, keeping to a healthy weight and regular physical activity are also important.

Full article can be read at http://www.nhs.uk/news

Behind the Headlines

Behind the Headlines provides an unbiased and evidencebased analysis of health stories that make the news. The service picks two popular health stories from the national media every day and aims to respond to them the same day they appear in the press. The service is intended for both the public and health professionals, and endeavours to: • explain the facts behind the headlines and give a better understanding of the science that makes the news • provide an authoritative resource that GPs can rely on when talking to patients • become a trusted resource for journalists and others involved in the dissemination of health news Bazian, a provider of evidence-based healthcare information, produces impartial evidence-based analyses, which are edited and published by NHS Choices www.nhs.uk

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ARTHRITIS RESEARCH UK

At-risk women 'underestimate likelihood of fractures' Postmenopausal women with conditions such as Parkinson's disease and multiple sclerosis (MS) tend to underestimate their risk of fractures, a study suggests. The bone-thinning disease osteoporosis mainly affects women following the menopause, greatly increasing their chances of fracturing a bone.

Yet almost half (43 per cent) of women with a neurological disorder thought their fracture risk was similar to other females of the same age, with a further 28 per cent assuming their risk was lower.

Dr Celia Gregson, who worked on the Global Longitudinal Study Women with some neurological conditions, rheumatoid of Osteoporosis in Women (GLOW), revealed: "We compared selfarthritis or a history of stroke are at least twice as likely to perceived fracture risk and three-year incident fracture rates sustain a fracture post-menopause as other women in postmenopausal women with a range of conditions of the same age. But research presented at the and found that while their risk of fracture was well Researchers anniversary congress of the European Calcified above the norm, they tended not to see this Tissue Society in Portugal (May 18th to 21st) risk." at the University of shows that many are unaware of this extra The researcher called for improved health risk.

Southampton’s MRC education for these women to help them Researchers at the University of understand the risks associated with their Lifecourse Southampton's MRC Lifecourse condition and motivate them to lead Epidemiology Unit Epidemiology Unit studied 43,832 women healthier lifestyles. over a three-year period. studied 43,832 women A spokeswoman for Arthritis Research UK said that awareness of the risks of During that time, 6.7 per cent of the over a three-year osteoporosis and of fracture was generally low. participants fractured a bone and women with period Parkinson's disease were found to be almost four "As well as a wide range of effective drug times as likely to sustain a fracture as those who therapies that reduce risk of fractures being available, were disease-free. there are many other things that at-risk women should be Women with MS were also shown to face an increased risk of encouraged to do, such as physical activity and having a healthy fractures, compared with women without any neurological diet containing plenty of calcium and vitamin D," she added. disorders.

Weight loss may reduce gout flares by suppressing inflammatory response Obese patients with gout may benefit from undergoing bariatric surgery, as the resulting weight loss could help to reduce the frequency of their gout flares, new research suggests.

Previous research has shown that weight loss only leads to a small reduction in concentrations of urate - which forms crystals in the joints of people with gout - yet can bring about a major reduction in gout flares.

Scientists at the University of Auckland in New Zealand therefore suggested that weight loss may lead to improvements in gout by influencing inflammatory responses to monosodium urate crystals in the joints. The team recruited 20 patients with type-2 diabetes and a body mass index (BMI) of 35 or higher, making them morbidly obese, but no history of gout. All of the patients underwent bariatric surgery and were assessed for various markers of inflammation both before and after the procedure.

The researchers found that patients typically lost about 25kg over an average follow-up period of 256 days. Participants showed significant reductions in inflammatory responses to monosodium urate crystals.

Publishing their findings in the Annals of the Rheumatic Diseases, the study authors concluded that weight loss following bariatric surgery "is associated with reduced inflammatory responses to monosodium urate crystals".

"These findings provide support for the concept that, in addition to urate lowering, weight loss has the potential to reduce the risk of gout flares through suppression of inflammatory responses to monosodium urate crystals," they added.

A spokesman for Arthritis Research UK said the study was in very small numbers of people, and hardly applicable to the majority of gout sufferers.

The charity is currently funding a clinical trial testing the effectiveness of a nurse-led package of care for up to 700 gout patients. The package of care includes using escalating doses of drugs rather than a fixed dose, to reduce urate levels in those people in whom there are specific indications for urate-lowering drug therapy.

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ARTICLE

President’s Address Dear Members, Directors, Fellows.

Welcome to this the 58th Annual General Meeting of the Institute of Chiropodists and Podiatrists. On behalf of the Chairperson, and Directors, I wish you a successful conference and the warmest of welcomes. I am personally delighted to see you here and we all look forward to enjoying each other’s company.

There is an old Chinese proverb which is actually said to be a curse; ‘May you live in interesting times’, that has certainly been true for the last 12 months, as have the other two parts of that proverb, ‘May the government be aware of you’, thank the gods for the HCPC, and the final part says, ‘May your wishes be granted’. This is kind of like saying be careful what you wish for.

Every curse has an effect, if you believe in that sort of thing, and every proverb can be interpreted in many ways; in any growing organisation change is inevitable, sometimes painful and often unexpected. The past year has seen great change, change that has consolidated us as an organisation and prompted us to closely examine our values, our mission and our direction.

The HCPC has been busy asking some of us questions, which is true to the second part of Chinese proverb about being brought to the attention of government.

Popular belief is that the Institute is on a downward spiral. This could not be further from

the truth. Our membership is growing; we are generating great interest from university students and others. This is not what one expects of an institution in decline. With your help we will continue to grow in strength and numbers. My wishes for this Institute, is that it continues to grow and my wishes always come true.

The Board of Directors over the past months has worked particularly hard to address questions from you the membership and the trade as well as quashing spurious rumours. Colette, our Chairperson elect has a number of interesting and exciting announcements to make with respect to the direction of the Institute as well as developments in education and planning.

The reason I am still here is because of you, the members of this Institution. Almost every week over the past few months I have had phone calls of support from people whose names I know but whose faces, much to my disgrace, I don’t remember.

You are the Institute, you are the future, you have stood by this board, as long as you are here we, this membership team will stand by you.

Are we in decline? No! Are we armatures?

No, we are no one’s poor relation; we are no one’s joke. We ARE The Institute of Chiropodists and Podiatrists and we are here to stay.

Good Morning, enjoy. Thank you Robert Sullivan, Acting President

Top to Bottom: Catherine O’Leary receiving the President’s Prize from Acting President Robert Sullivan; Martin Pearson receiving honorary membership from Acting Chairman Colette Johnston; Malcolm Holmes receiving award of merit; Michelle Holmes receiving the Basham Literary Prize from editor Mrs B Hawthorn; Martin Pearson presenting the Mayor of Southport, Councillor Maureen Fearn with a bouquet of flowers; Graduate, Sue Rylance receiving student of the year award.

Below: Photos of conference and the dinner dance.

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TRADE SHOW

2013 TRADE SHOW EXHIBITORS The Institute would like to thank the following sponsors of Its 58th Annual Conference

Algeos Ltd; Advancis Medical; Aspen Medical Europe Ltd; Bailey Instruments; Beehive Medical Solutions; Body Block; C & P Medical, Canonbury, Chas E. Prossor; Chiropody Express; Cosyfeet (The Footshop); Currie International; Cuxson Gerrard and Co Ltd; D. L. Townend Son and Sandy; Evercare Ltd; Footbalance Systems Ltd; Healthy Steps; Hilary Supplies; Kent Pharmaceuticals; Link-Up Ltd; MDS Medical; Sidas; Tyndale Computers Limited, Wider Fit Shoes (D.B. Shoes)

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INFORMATION

Keeping Feet Sweet – Hints and Tips on buying socks Chiropodists and Podiatrists do a wonderful job helping to keep as many of us on our feet as is possible – and without pain or discomfort. It goes without saying then that good foot care is paramount, but having the right additional components like good shoes and socks is vital too.

Naturally, as sockmakers with a heritage of over 131 years of making socks in England and abroad it is these, socks, the unsung heroes where our interest, knowledge and enthusiasm lies. With all this valuable knowledge we have compiled below the key components that our vast experience recommends you look for when buying these humble, yet most important items for maintaining good foot condition:• Always buy the best you can afford - cheap socks often use high content, poor quality, man-made fibres and have poor durability and bad moisture management. This can lead to excess perspiration and increased bacteria and therefore odour – they also don’t generally last long making bad financial sense too.

• Look for natural fibres – Cotton is better in warmer weather and wool is better when cooler climate – but both can be worn all year round. Both offer good moisture management and comfort.

• Buy the right size – take care to look at the size you are buying, too big would cause the socks to crease underfoot and too tight would be uncomfortable and restrict circulation • Check the elastic content – Lycra and Elastane are two of the best elastics, don’t buy anything else, and avoid anything with more than 5% except on medical or compression type socks • Non-elastic – these are ideal for those that suffer from diabetes, poor circulation, obesity, ulcers, and swollen or large ankles. HJ invented Softops™ the original non-elastic socks over 23yrs ago and to this day they remain the market leader with many tens of millions of pairs having

been sold, we even make extra wide versions now too (watch out for non-elastic socks with elastane in them as they are not true non-elastic socks – Softops™ are).

• Look for additional features – there are many of these suitable for different socks with different uses, but the most popular that have the most benefit are:o Cushioned sole for extra comfort and protection o Ventilated foot panels for improved breathability o Reinforced heal and toe for extra durability and protection o Comfort top for a relaxed grip o Full terry for additional protection in key areas o A guarantee of quality (All HJ socks come with a minimum 6 month unconditional guarantee) It is very easy to think it is “just socks” but having supplied the British Military forces for many years and having sold many millions of pairs of our famous socks (including Softop™, Diabetic, Protrek™, Extra Wide, Flysafe™, Energisox™, Commando™ etc.,) we can’t emphasise enough the importance of wearing the right socks for the right circumstances.

After a thorough testing too, we are pleased and proud that the Institute of Chiropodists and Podiatrists (IOCP) agree with us and have endorsed two of our most popular socks - the Softop™ and the Diabetic. HJ socks can be found in stockists all around the world, in independent retailers, departmental stores, shoe shops, Chiropodists, Podiatrists and in many places on line too - so we can’t all be wrong can we?

Think great socks – think HJ To find our more or to become a stockist, take a look at our website www.hjhall.com page | 25

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BRANCH NEWS

Wolverhampton Branch Wolverhampton Branch were given the opportunity to attend a free training day at Langer Orthotics which comprised of a comprehensive tour of the manufacturing process, partake in an in depth prescription writing session and a presentation on 3D scanning and new product ranges.

We arrived at 9.30 to be given tea and coffee and meet the staff and the other people attending the course. We were a mixed bag of Podiatrists, physio therapists, chiropractors and shoe shop owners. The day started with a demonstration on how to use the 3D scanning machine and software which entailed the patient placing their foot on the glass scanner, which took various scans and then down loaded to the laptop, where you could then study the foot structure in more detail.

All the information could then be collated and the relevant othosis prescribed.

All this information could then be emailed over to langer and the orthotic device made and delivered.

Then we were shown how to work our way through an orthotic prescription form ready for processing. By this time our brains had gone into meltdown so we had a break for a quick cup of coffee and then it was a guided tour of the manufacturing process.

We went from the office where the orders are processed through to the next room which is where the plaster of Paris moulds are made ready for the orthotics to be moulded around. The next room was really high tech with the laser scanning orders been processed and the moulds being cut by large robotic machines out of MDF or plastic.

The moulds are then taken through to the factory floor, where the process of making the orthotic begins. A sheet of the required density plastic is placed in a heating oven and when hot enough, placed on top of the mould which is then placed into a vacuum press, where the plastic sheet is shaped to the required shape.

The mould is then stored for six months in case extra sets are required at a later date. The orthotic is then trimmed and the 26 | page

wedges, raises and foams are added to the orthotic and then it’s onto the final stage where the top covers are added to suit and the orthotic is now complete.

Before the orthotics are shipped out to the podiatrist they go through a strict quality control to make sure everything is up to the required standard.

As you can see from the photographs it is quite an involved process.

After lunch we were given a presentation on the new lines of footwear they were bringing out and asking us for feedback on the styles and colours. They seem to be aiming at the Hotter style footwear wearer, the difference being that their range has deep removable insoles, roomy toe box, smooth internal lining, extra wide fittings and the ability to split sizes.

Our day spent at Langer was a really interesting and enjoyable day, with the chance to see behind the scenes at how orthotics are made.

If given the opportunity to attend one of these open days, I highly recommend it. Our branch members had a great day out . Hopefully it may have spurred some of them on to take up biomechanics as an extra service in their practices.

David Collett, Branch Secretary

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BRANCH NEWS

Western Branch The Western Branch has had two very well attended outings this month. The first a branch meeting at the Women's Hospital on 14th April where all attending members were given an insight into the 'Care and Abuse of the Elderly' by Sue Cavaney, followed by an informal, informative talk by two of our own members, Julia Franklin and Gary Munro.They gave us an insight into surviving an HCPC audit. Both Julia and Gary have done just that and were willing to share the experiences it brought with other 'terrified' Western Branch members, which I have to say we are very grateful for! Sue Cavaney very kindly stepped into the breach at the last minute but never the less gave a very informative talk on different types of abuse she and other professionals such as ourselves encounter, how to identify abuse to others and also identify the abusers that inflict it.

She then went on to inform us how to officially report any suspicions that we may have to the correct authorities.

On 21st April, 18 of our members attended a first aid course organised by Linda Pearson. This was run by a very entertaining Roy Aldcroft [formerly of the ambulance service] who delighted his audience with vital information on saving the lives of others and how to deal with injuries that we may come across in our day to day lives. This necessary requirement was very enjoyable and informative and made interesting by the experiences and "priceless" anecdotes of Mr.Aldcroft and also a few quips added by our own experiences out in the field! All members that attended seemed to thoroughly enjoy the day.

Hazel Carruthers

Warning over bogus HCPC calls Bogus HCPC calls

The HCPC are warning members that they have received reports that employers of HCPC registrants are being targeted by bogus callers, claiming to be from the HCPC and requesting personal information.

The HCPC will never call and request this information. Please be vigilant and do not volunteer any personal information to scam callers.

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SUSSEX BRANCH

BRANCH NEWS

At the Bent Arms, Lindfield, Nr Haywards Heath, West Sussex RH16 2HP Sunday 15th September 2013 at 9 am for 9.30 am start

Sussex Branch is delighted to present a Study Day

With well-known Biomechanics Specialist Robert Isaacs

‘Biomechanics for Everyone’ – an informal, practical and fun day of learning to include: •

Evolution of biomechanics with practical anatomy

•

Optional mid-afternoon workshop for those wishing to know more on prescribing and casting orthotics in Private Practice

•

What to do when a patient tells you their foot hurts – assessment techniques

Also Belinda Longhurst (Private Practitioner) will be kicking off the day with an informal and informative discussion on the aetiology and latest treatment of verrucae pedis And Canonbury will be there on the day with their trade stand!

Cost of the day is £40 to include a delicious buffet lunch and refreshments.

If you would like to attend please complete the booking form below and return by early September. Or for further information call Valerie Probert-Broster on 01273 890570 or email IOCPSussexBranch.live.co.uk EVERYONE WELCOME!

Booking Form

Biomechanics Study Day with lunch and refreshments on Sunday 15th September 2013 at the Bent Arms, Linfield, RH16 2HP

9 am for 9.30 am start

Name…………………………………………………………………………………………………………………………………………………..………..…

Address ………………………………………………………………………………………………………………….…………………………..………..… ………………………………………………………………………………………..………Post Code………………………………………….………..…

Branch…………………………………………………………………………………………………………….…………………………………..………..…

Tel…………………………………………… Email …………………………………………………………………………………………...………..….…

Please send a cheque for £40 made payable to IOCP Sussex Branch and send to Valerie Probert-Broster, The Rectory, Plumpton, Lewes BN7 3BU by early September. page | 29

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 32

INFORMATION

Some information for you and new UK Law 11th May saw the The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 come in to force as part of UK law. Reflecting upon this new legislation, it is primarily aimed at the healthcare sector and would include Hospitals, Care Homes and other employers involved in the managing, organising and provision of Healthcare.

of containers are also required.

• The Regulations place a duty on the employee to report any incidents or injury involving sharps.

• Arrangements must be made which includes recording, treatment, investigating, preventing further recurrences, support and counselling for any person affected.

Therefore, it will have an impact on all foot healthcare professionals who use "medical sharps" in their line of business; regardless of whether they are in private practice or NHS, clinic based or within a domiciliary setting.

These new "Sharps Regs" can be found at... http://www.legislation.gov.uk/uksi/2013/645/pdfs/uksi_20130 645_en.pdf

The regulation requires Employers to avoid so far as is reasonably practicable the use of medical sharps.

There's also more useful information and guidance provided by The Royal College of Nursing... http://www.rcn.org.uk/__data/assets/pdf_file/0008/418490/00 4135.pdf

For the purpose of this specific piece of UK Statute, “medical sharp” is defined as an object or instrument necessary for the exercise of specific healthcare activities, which is able to cut, prick or cause injury. So, that's predominantly going to be a blade (scalpel or otherwise) and needle (hypodermic, acupuncture etc).

However:

• If avoidance is not possible then safer sharps should be used where possible. Instruction training and marking

...and the Health & Safety Executive (HSE) - the government body tasked with overseeing, inspecting and enforcing the legislation has provided guidance for both employers and employees at... http://www.hse.gov.uk/pubns/hsis7.pdf

Don't forget, that not only is this CPD, but it could also ensure your working environment safer for both you and your patients!

New DBS (Disclosure and Barring Service) replaces CRB The Disclosure & Barring Service’s (DBS) new online Update Service will be available from the middle of June 2013. From that date (17th) anybody who applies for a DBS check may subscribe to the Update Service for an additional fee of £13 per year. This will enable their criminal record certificate to be kept up to date so that it can be used when they change jobs or role within the same type of workforce.

Individuals may also give their consent to prospective employers enabling them to carry out a free, instant online check of the individual's certificate.

• A new criminal record check will only be needed if the system confirms that something has changed.

• Any benefit arising where an employer pays or reimburses fees paid by an employee to subscribe to the Update Service will be exempt from tax • The reimbursement of fees for the actual checks will also be exempt from tax.

• Copies of an individual's DBS certificate will no longer be sent to registered bodies.

There are four categories of 'workforce':

• working/volunteering with children

30 | page

• working/volunteering with adults

• working/volunteering with both children and adults

• 'other'(ie one which involves working with neither children nor adults, such as a security guard).

An adult conviction will be removed from a criminal record certificate if: • 11 years have elapsed since the date of conviction • it is the person's only offence

• it did not result in a custodial sentence and

• it does not appear on the list of specified offences.

A conviction relating to somebody under the age of 18 at the time of the offence will be removed after 5.5 years, unless it is on the list of specified offences.

An adult caution will be removed after six years and two years for a young person if it does not appear on the list of specified offences.

Question e55 on the application for a criminal record check is being changed and applicants should now regard this as asking whether they have any unspent convictions, cautions, reprimands or warnings.

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 33

INFORMATION

page | 31

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 34

DIABETES NEWS

NICE recommends new drug for some with Type 2 diabetes

The use of a new drug for some people with Type 2 diabetes has been recommended in final draft guidance issued today by the National Institute for Health and Clinical Excellence (NICE).

The drug, dapagliflozin, helps to maintain blood glucose control by the blocking the re-absorption of glucose in the kidneys and promoting excretion of excess glucose in the urine.

The draft NICE guidance recommends the use of dapagliflozin, which is also known as Forxiga, in combination with metformin, which acts to lower blood glucose levels. In some cases, dapagliflozin can also be used in combination with insulin.

The manufacturers of the drug, Bristol-Myers Squibb and AstraZeneca, estimate that it could be suitable for up to one million UK patients. Dapagliflozin has not been recommended for use in treating Type 1 diabetes.

NICE has not yet issued final guidance to the NHS; these

decisions may change in the event of an appeal. The final decision on the use of dapagliflozin is due to be published in June 2013.

In the interim, NHS bodies are able to make decisions locally on the use of the drug.

Professor Carole Longson, Health Technology Evaluation Centre Director at NICE, said, "We are pleased to recommend dapagliflozin for some people with Type 2 diabetes. It is a serious problem in the UK and dapagliflozin provides another treatment option for some people with this condition."

Libby Dowling, Clinical Advisor for Diabetes UK, said, "We welcome any new treatment options that help people with diabetes manage their condition, though we note that this is draft guidance and could yet change before a final version is issued."

Further information on the final draft guidance can be found on theNICE website.

Vaccine for Type 1 diabetes "could be available within 20 years"

A vaccine for Type 1 diabetes that could transform the lives of those at high risk of the condition could be available within the next 20 years, according to Diabetes UK. Speaking following a summit meeting of leading experts, Dr Alasdair Rankin, Diabetes UK’s Director of Research, said that a vaccine for Type 1 diabetes is now a realistic prospect. This would represent the biggest single breakthrough in diabetes research since insulin was first successfully used to treat Type 1 diabetes 91 years ago.

Decades of work by scientists have identified a long list of different parts of the immune system that could be potential targets for treatment. Many of these have been tested in clinical trials, which initially disappointed the research community.

However, after following these studies for a number of years, scientists have realised that treatments that fall short of preventing development of Type 1 diabetes altogether could still potentially reduce health complications if they give patients even a slightly longer period before they have to take insulin or allow them to continue to make small amounts of their own insulin.

Together with an increased understanding about how the immune system works in diabetes, there is real excitement about the potential for new approaches and combinations of existing treatments to make a much bigger difference.

Tesco’s decision to make Diabetes UK its National Charity Partner – its employees and customers aim to raise £10 million – has enabled Diabetes UK to announce the biggest single research programme in the charity's history to look into a Type 1 vaccine.

There is now real hope that a vaccine will be available within the next 20 years.

Dr Rankin said, "We tend to think of Type 1 diabetes as unavoidable, but there is a huge sense of excitement in the research community that the work being done today is building towards a future where Type 1 diabetes can be stopped in its tracks.

32 | page

"This is not, of course, going to happen overnight. It is likely that the first vaccines we see will allow people to live longer before they develop Type 1 diabetes, rather than preventing it entirely. But we know that if people who do develop Type 1 diabetes are treated early with a vaccine then it could provide some benefits that make their condition easier to manage and improve their health in the long term.

"We would also expect treatments to get gradually better as we understand more about how the immune system works in people with Type 1 diabetes.

"While there will be difficulties to overcome, I am really hopeful that with the boost of the funding that has been made possible by our partnership with Tesco, within the next 20 years we will have a vaccine that can stop Type 1 diabetes developing.

"When you think that there are 300,000 people in the UK with Type 1 diabetes, and that all of them have the daily struggle of managing their condition and die up to 20 years younger than people without the condition, the benefit of a vaccine would be enormous. It has the potential to be one of the really big medical breakthroughs in the first half of the 21st century."

The aim of this week’s summit meeting was to explore the latest research in diabetes vaccine development. The discussions at the summit will now be used to develop a call, inviting the leading researchers in this area to apply for funding for research that will move us towards being able to prevent Type 1 diabetes as quickly as possible. That call for proposals will be issued by the end of the year, with a decision on how the funds are allocated expected by next summer.

Michael Kissman, Community Director at Tesco, said, "Working in this partnership, I’ve met many people coping with the difficulties this condition can bring. It is hugely exciting that through the generosity of our colleagues and customers, we can contribute to a possible future without Type 1 diabetes and also help all those who are currently living with diabetes in the UK."

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 35

CLASSIFIED To advertise in this section and on our website Call 01704 546141 or email bernie@iocp.org.uk

COLCHESTER, ESSEX - RETIREMENT SALE

Busy Foot Health Practice Close to Colchester Essex Established 7 years. Scope for expansion.

All equipment included.

Transitional help if required.

Please contact 07857 822906

TORQUAY, DEVON - RETIREMENT SALE

Surgery and Domiciliary Established 25 years Income £17k over 3 days. Plenty of Scope for Expansion. Price £15K Telephone 01803 211616 CHESTER For sale a Podiatry Clinic on the outskirts of Chester. Turnover of 68k per annum.

The practice has a large customer base and the sale includes all equipment. The leased clinic is currently open 4 days per week and has two treatment rooms.

A business overview and valuation document is now available.

Email scgriffiths@me.com Telephone 01244 303215 / 07920 864797

Employment Chiropodist/podiatrist wanted

for central London clinic. Every other Saturday 9am till 2pm. Salary negotiable.

Please send CVs to bernie@iocp.org.uk WARWICKSHIRE Podiatrist required to join busy, expanding practice on self employed basis.

For more information contact Kate on 07762 038201.

Classified Section ANDOVER, HAMPSHIRE Visiting practice established over 25 years.

Turnover £14,000 over 2 days.

Scope for expansion as have already semi-retired.

Transitional help if required.

Past and present accounts available for inspection. £9,000 negotiable.

Email or phone for a chat roshanson@hotmail.com or 07989 254636

EQUIPMENT/SUPPLIES FOR SALE

FULL PODIATRY EQUIPMENT FOR SALE, CLINIC CLOSING, SOUTH LONDON. 07783 363 965 / 0208 769 6206

Chiromart UK “WHY PAY MORE?”

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

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

page | 33

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 36

ARTICLE

Cosyfeet is thriving after 30 years in business selling extra roomy footwear. What’s their secret?

Shoes for Swollen Feet

A significant proportion of podiatry patients have swollen or misshapen feet and need properly fitting footwear that shoe shops just don’t stock. Having the right pair of shoes or slippers can mean the difference between being able or unable to walk.

So where do people who need extra roomy footwear go to buy their shoes? Many shop direct from the Cosyfeet website or mail order catalogue. Others visit the Cosyfeet shop in Street, Somerset, or go to one of the growing number of mobility shops who stock the Cosyfeet range.

Cosyfeet styles are aimed at an increasing style-conscious customer.

Back in the early 1980s before Cosyfeet first started trading, there were plenty of potential customers for extra roomy footwear but not a single source of supply in the UK. People with problem feet often had to put up with pain, minimum mobility and large slices cut out of their shoes to try to make them more comfortable.

Cosyfeet was started in Bristol by a husband and wife team who realised the great need that existed for extra roomy footwear.

Initially they launched just three shoe styles using a back bedroom as an office and a garage as a warehouse. The business was a success, but as they approached retirement age they decided to sell it as a going concern, and in 1991 it was bought

by David Price, a former manager with Street-based Clarks shoes.

Using his wealth of experience in the shoe trade, David Price was able to expand the business at its current location in Street.

He placed great emphasis on developing and improving styles based on customer feedback, creating shoes that fitted well, offered support and comfort, and were aesthetically pleasing.

In 2011, having nurtured the business for 20 years, David Price

34 | page

sold Cosyfeet to its Executive Board, who together have over 30 years combined experience working with the company.

Cosyfeet is now led by Managing Director Andrew Peirce, who has an evolution not revolution approach to the business.

“The Company is a good one, made up of many excellent & committed people,” says Andrew Peirce. “We’ve weathered the recent challenging economic conditions well and we’re excited about the future.”

The Cosyfeet men’s range includes classic styles to meet a range of footwear needs.

Andrew goes on to say, “Looking ahead we intend to uphold the company’s core values of excellent product and first class customer service. For example, our no quibble money back guarantee and extensive product advice available by phone are both really important to our customers.”

The UK population is ageing and it is predicted that a growing percentage of us will be affected by mobility issues in our latter years. Many more people than currently will need extra roomy footwear. In particular, the increase in diabetes in the UK will fuel the need for extra roomy footwear designed to protect feet made vulnerable by the disease.

Health experts agree that the UK is facing a huge increase in the number of people with diabetes. The charity Diabetes UK reports that since 1996 the number of people diagnosed with diabetes has increased from 1.4 million to 2.9 million. By 2025 it is estimated that five million people in the UK will have the disease. Most of these cases will be Type 2 diabetes, because of

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 37

ARTICLE our ageing population and rapidly rising numbers of overweight and obese people.

As podiatrists know, one of the most potentially worrying side effects of diabetes is peripheral neuropathy. Feet in poorly fitting footwear can lead to minor injuries which cannot be felt, and are therefore left untreated. Added to this, people with diabetes do not heal as well as those without the disease, so minor injures can become infected, leading to amputations. Finding the right footwear can prevent very serious and avoidable problems for diabetes sufferers.

The challenge to Cosyfeet is to meet the demands of a new generation of younger customers who, due to the current obesity epidemic, require an extra roomy slipper or shoe which fits well and provides excellent support but has a younger, more fashionable look.

“This year we’ve added new styles to cater for customers who are younger, or who have a younger outlook in terms of style,” says Marketing Manager Julia Edwards. “We need to offer shoes suitable for men and women in their forties and fifties, but we’re also finding that our older customers are far more style conscious than their predecessors.”

“It’s vital that footwear needs to fit properly and provide support without chafing,” says Julia. “Most customers, whether or not they have diabetes, need good quality, soft leather shoes, which is what most of our range consists of, but for feet that are very hard to fit we also sell a range of shoes with elastane that stretch to fit bunions, hammer toes and swelling.”Cosyfeet sells two pairs of slippers for every pair of shoes, and just like shoes, these are designed to fit well without chafing. The company also sells its own range of extra roomy socks and hosiery which fulfills a real need for many customers.

In recent years an extensive campaign of daytime TV advertising has successfully raised Cosyfeet’s brand awareness among its target market, providing people who need extra roomy footwear with information about where to buy the shoes they need. Potential customers access the website, or telephone the call centre, either for a catalogue, or to locate their nearest outlet for Cosyfeet footwear.

Cosyfeet was the first British company to make footwear for people with swollen feet. Thirty years on it still offers the biggest range of extra roomy shoes and slippers on the market.

Cosyfeet Announces Award Winner Sarah Laverty Glasgow Caledonian Podiatry student, Sarah Laverty, has been awarded the Cosyfeet Podiatry Award 2013.

Sarah, who has completed three years of her four year BSc Hons in Podiatry, plans to use the £1000 award for her travel and living expenses when she volunteers in and around the Bogota area of Colombia this summer. She will be working under the guidance of eminent US podiatric surgeon Dr Mike Haughey, providing free treatment to impoverished communities at temporary clinics.

Sarah will help to provide basic podiatric care such as nail debridement, matrixectomies for paronychia, drainage of abscesses and debridement of hyperkeratosis/warts. She will administer local anaesthetic as well as cortisone injections for foot and ankle inflammation, and will perform minor surgical procedures including excision of skin lesions, tenotomies and wound debridements under supervision.

Sarah also hopes to participate in orthopaedic operative procedures conducted by Dr Mike Haughey, which could address conditions such as talipes equinovarus, heel spur and ankle fractures.

“It’s reasonable to expect that many patients will present with complex medical issues due to the level of poverty in Bogota,” says Sarah. “I’m looking forward to helping people as much as I

can with the clinical skills I have gained at Glasgow Caledonian. I also hope to broaden my clinical experience through exposure to procedures and methods of treatment I haven’t previously encountered.”

Now in its eighth year, the Cosyfeet Podiatry Award assists podiatrists and podiatry students to develop their professional knowledge and skills while benefitting others. The award is open to those who are planning voluntary work, a work placement or research, whether in the UK or abroad. It is designed to contribute to travel and living expenses.

“We have been so impressed with the standard of entries this year,” says Cosyfeet Managing Director, Andrew Peirce. “We’re delighted to be able to assist Sarah with the valuable work she plans to do in Colombia.”

Cosyfeet is the UK’s leading supplier of footwear, socks and hosiery for extra wide, swollen or problem feet. 11,000 health professionals recommend Cosyfeet products to their patients. For more information email prof@cosyfeet.co.uk or call 01458 447275.

For more information about the Cosyfeet Podiatry Award see www.cosyfeet.com/professionals. page | 35

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 38

DIARY

What’s on in your area?

July 2013 6 8

Surrey and Berkshire Branch Meeting 1:30 p.m.

Greyfriars Centre, Reading Berkshire Tel: 0208 660 2822

West Middlesex Branch Meeting 8:00 p.m.

The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544

21 Leicester and Northants Branch Meeting Kelsby Village Hall Tel: 01234 851182

28 Wolverhampton Branch Meeting 9:00 a.m.

4 Selman’s Parade, Selman’s Hill, Bloxwich, Walsall, WV3 3RN Tel: 0121 378 2888

August 2013

28 London Branch Meeting 7:30 p.m.

Ozzie Rizzo, 14 Hay Hill, Mayfair, London W1J 8NR Tel: 0208 586 9542

September 2013 1

1 6

West of Scotland Branch Meeting 11 a.m.

Express by Holiday Inn, Springkerse Business Park, Stirling, FK7 7XE Tel: 0141 632 3283 Scottish Area Council Meeting

East Anglia Branch Meeting 10.00 a.m. for 10.30 a.m. prompt With autoclave servicing (contact Julie Garwood garwoodjulie@yahoo.co.uk or 01473 310155) Barrow Village Hall, Bury St Edmunds IP29 5DX Tel: 01992 589063

9 West Middlesex Branch Meeting 8 p.m.

The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544

14 Southern Area Council Meeting 1 p.m.

Victory Services Club 63-79 Seymour Street, London W2 2HF

17 North West Branch Meeting 7.00 p.m.

St Joseph’s Parish Centre, Harpers Lane, Chorley, Lancs

Tel: 01992 589063

Tel: 0161 486 9234 Includes CPD Presentation

20 Birmingham Branch Meeting 8 p.m.

British red Cross Centre Evesham, Worcs.

Tel: 01905 454116

36 | page

22 Sheffield Branch Meeting 10.00 a.m.

SWD Sports Club, Heeley Bank Road, Sheffield S2 3GL Tel: 01623 452711 N.B. This replaces the meeting scheduled for 18th October

22 Western Branch Meeting 12.15 p.m.

Blair Bell Education Centre, Liverpool Women’s Hospital, Crown Street, Liverpool Presentation: “Tissue viability” and trade stand.

Tel: 01745 331827 27/ Executive Meeting Head Office 28 150 Lord Street, Southport PR0 0NP

Tel: 01704 546141

29 Essex Branch Meeting 2 p.m.

Southend University Hospital Education Centre Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890 29 Nottingham Branch Meeting 10.a.m.

Willow Tree House, Main Street, Little Hurnby, Grantham NG33 4HW

Tel: 0115 931 3492

October 2013 2 6

6 7

Hants and Dorset Branch Meeting 7.45 p.m.

Crosfield Hall, Broadwater Road, Romsey SO51 8GL Tel: 01202 425568 Cheshire North Wales, Staffs and Shropshire Branch Meeting 10 a.m.

The Dene Hotel, Hoole Road, Chester Tel: 0151 327 6113 Leeds Bradford Branch Meeting 10 a.m.

Oakwell Motel, Leeds WF17 9HD

Tel: 01924 475338

Surrey and Berkshire Branch Meeting 7.30 p.m.

Pirbright Village Hall, Pirbright, Surrey Tel: 0208 660 2822

27 Northern Ireland Branch Meeting Lagan Valley Hospital

Tel: 028 9446 2423

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 39

DIARY 27 Wolverhampton Branch Meeting 9.30 am 4 Selman’s Parade, Selman’s Hill, Bloxwich, Walsall, WV3 3RN Tel: 0121 378 2888 27 Leicester and Northants Branch Meeting Kelsby Village Hall Tel: 01234 851182

November 2013 3

Leeds Bradford Branch Meeting 10 a.m.

Oakwell Motel, Leeds WF17 9HD

3

Scottish Area Council Meeting

3 3

Tel: 01924 475338

South Wales and Monmouth Branch Meeting 2 - 4p.m.

Venue to be arranged.

Tel: Esther 01656 740772 West of Scotland Branch Meeting 11 a.m.

Express by Holiday Inn, Springkerse Business Park, Stirling, FK7 7XE Tel: 0141 632 3283

11 West Middlesex Branch Meeting 8 p.m.

The Harvester, Watford Road, Croxley Green, Rickmansworth WD3 3RX Tel: 0208 903 6544 13 London Branch Meeting 7. 30 p.m.

Ozzie Rizzo, 14 Hay Hill, Mayfair, London W1J 8NR Tel: 0208 586 9542

24 Essex Branch Meeting 2 p.m.

Southend University Hospital Education Centre Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890

24 Leicester and Northants Branch Seminar Lutterworth Golf Club Tel: 01234 851182

December 2013 1

Leeds Bradford Branch Meeting 10 a.m.

Oakwell Motel, Leeds WF17 9HD

6

Hants and Dorset Branch Christmas Social Meeting 7.45 p.m.

Crosfield Hall, Broadwater Road, Romsey SO51 8GL Tel: 01202 425568

Tel: 01924 475338

January 2014 5

Leeds Bradford Branch AGM 10 a.m.

Oakwell Motel, Leeds WF17 9HD

14 North West Branch AGM 7.00 p.m.

St Joseph’s Parish Centre, Harpers Lane, Chorley, Lancs Tel: 0161 486 9234 15 Hants and Dorset Branch AGM 7.45 p.m.

Crosfield Hall, Broadwater Road, Romsey SO51 8GL Tel: 01202 425568

16 Birmingham Branch AGM 8 p.m.

British Red Cross Centre Evesham, Worcs.

Tel: 01905 454116 17 Sheffield Branch AGM 7.30 p.m.

SWD Sports Club, Heeley Bank Road, Sheffield S2 3GL Tel: 01623 452711

17 East Anglia Branch AGM 10.30 a.m.

Barrow Village Hall, Bury St Edmunds IP29 5DX Tel: 01992 589063

19 Essex Branch AGM 2 p.m.

Southend University Hospital Education Centre Carlingford Drive, Southend on Sea SS0 0RY Tel: 01702 460890 19 West of Scotland Branch AGM 11 a.m.

Express by Holiday Inn, Springkerse Business Park, Stirling, FK7 7XE Tel: 0141 632 3283 25 Southern Area Council AGM 1 p.m.

Victory Services Club 63-79 Seymour Street, London W2 2HF 26 Leicester and Northants Branch AGM

11 Surrey and Berkshire Branch AGM 1.30 p.m.

Greyfriars Centre, Reading Berkshire Tel: 0208 660 2822 12 Western Branch AGM 12.15 p.m.

Blair Bell Education Centre, Liverpool Women’s Hospital, Crown Street, Liverpool Tel: 01745 331827

Tel: 01234 851182

28 London Branch AGM 7. 30 p.m.

Ozzie Rizzo, 14 Hay Hill, Mayfair, London W1J 8NR Tel: 0208 586 9542

February 2014 2 2

Tel: 01924 475338

Tel: 01992 589063

Northern Ireland Branch AGM Lagan Valley Hospital

Tel: 028 9446 2423

Midland Area Council Meeting and AGM Kilsby Hall, Hall Lane, Kilsby CV23 8XX Tel: 01536 269513

March 2014

21 Sheffield Branch Meeting 7.30 p.m.

SWD Sports Club, Heeley Bank Road, Sheffield S2 3GL Tel: 01623 452711 page | 37

41359 Chiropody July-Aug 2013 20/06/2013 15:38 Page 40

For all things Podiatry!

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CRYOSPRAY 59 Breathable hypoallergenic adhesive tape, in various sizes for dressing retention

The professional solution for effective Verruca and Wart removal

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The softer way to protect feet. Protects and cushions, whilst moisturising and lubricating