Kate Springett

Epidemiology of plantar forefoot corns and callus, and the influence of dominant side

Abstract Corns and callus are frequent complaints but detailed epidemiological information is lacking. Three surveys were undertaken; one of an employed group and two surveys, 5 years apart, of podiatry patients to identify plantar callus incidence and any change in the population with time. The influence of dominant side on gait and callus formation was studied using the Kistler force plate. A minimum of 18% of a working population appear to have suffered at some stage with plantar callus, and the mode ages of onset was years with increased frequency in women. Callus formation develops uni- or bilaterally regardless of side of dominance ( P >0.05). There was no significant difference between dominant side and duration of foot loading times ( P >0.05). The magnitude of vertical loading in left and right dominance showed good correlation between left and right side ( r =0.91), also suggesting that dominant side does not influence this gait parameter.

Introduction to some common cutaneous foot conditions and their management.

Problems that happen to the body through injury or disease can also happen to the owners feet, and there are additional complications associated with the feet. Feet are a long way from the core, are in contact with an unclean environment (the ground), can be abused through poor-fitting footwear and are subjected to more general wear and tear than many other parts of the body. There are a large number of conditions affecting the feet, many associated with medical disorders such as diabetes, rheumatoid arthritis or peripheral vascular disease. The symptom of pain often triggers help being sought, but change in the appearance of the skin is a very important indicator of the state of superficial and deeper tissues. Health-care professionals may be called upon to comment on these conditions and treat and/or refer accordingly, so a multidisciplinary approach is required. Clinical skill is required to identify the conditions which are treatable, or those which should be referred for treatment by someone in another specialism. This paper provides information for clinicians and interested others in the form of an introduction to some common cutaneous foot conditions through outline case examples and their treatment.

Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community: a qualitative study

Abstract Purpose: To explore the experiences of individuals who have had a severe traumatic brain injury (TBI) and their carers in the first month post-discharge from in-patient rehabilitation into living in the community. Method: Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers. Results: Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future. Conclusions: Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead – this dissonance adds to anxiety. The study’s findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and carer, are at the center of service provision.

The role of outcome measures in assessing change in the at-risk rheumatoid foot

In common with other outcome measures, those for the at-risk rheumatoid foot need to be sensitive, specific and patient focussed, although currently these combined features are not available within one measure. There is also the issue of cross-validation with other commonly used measures to be considered. Both government policy and clinical need predicate development of suitable measures for the rheumatoid foot. In the first part of this paper, general issues relating to outcome measures and some government policy are considered and in the second, outcome measures relating to the at-risk rheumatoid foot are introduced alongside a discussion on the implications for practitioners.

Increasing radiology capacity within the lung cancer pathway: centralised work-based support for trainee chest x-ray reporting radiographers

Diagnostic capacity and time to diagnosis are frequently identified as a barrier to improving cancer patient outcomes. Maximising the contribution of the medical imaging workforce, including reporting radiographers, is one way to improve service delivery.