Scarf and Akin Osteotomies for Correction of Hallux Abducto Valgus. A Ten-year Retrospective Patient Evaluation From Five Podiatric Surgery Centres Using PASCOM PSQ-10.

BackgroundCorrective surgery for hallux abducto valgus is one of the most commonly performed elective procedures in foot and ankle practice, with over a hundred different surgical solutions having been proposed throughout the literature. The purpose of the study was to identify the clinical and patient reported outcomes following Scarf-Akin osteotomies from five podiatric surgery centres over a ten-year period.MethodThis is a retrospective review from five podiatric surgical units which looked at patients who underwent Scarf osteotomies (in isolation or in combination with Akin procedures) over a ten-year period. Data was collected from the patient satisfaction questionnaires of the PASCOM-10 audit tool, which were completed by the patient six months post operatively, and further analysed using Microsoft Excel spreadsheet software.ResultsA total of 1351 patients were recorded undergoing Scarf (with or without an Akin) osteotomy for hallux abducto valgus, with 1227 females (90.83%) and 124 males (9.17%) identified but with only 1189 who had completed the patient satisfaction questionnaire. 96.8% of patients felt that their foot was either ‘better’ or ‘much better’ following surgery and that their original expectations of surgery had been met. Over 75% of patients had no post-operative sequalae identified, with metatarsal fracture noted to be the highest sequalae at 4.8%.ConclusionFrom the five podiatric surgery units reviewed, Scarf osteotomies (with or without an Akin osteotomy) for hallux abducto valgus correction, have a high level of patient satisfaction with low post-operative sequalae.Level of clinical evidenceIV (retrospective review).

Rheumatoid Vasculitis Following Change to Naturopathic Remedies

A 66-year old femal with longstanding seropositive rheumatoid arthritis was admitted to the internal medicine service with bilateral foot pain and new painless raised fluid filled black lesions on her feet. Two weeks prior she underwent a right great toe amputation for "gangrene" by podiatric surgery. Five months prior, the patient discontinued all disease modifying therapies to pursue naturopathic remedies. The patient was diagnosed with rheumatoid arthritis vasculitis and despite immunosupressive therapies, the patient ultimately underwent bilateral transmetatarsal amputations for progression disease progression. This case reinforces the imporance for physicians to strongly discourage only using naturopathic remedies in rheumatoid arthritis and to consider vasculitis in any patient with rheumatoid arthritis presenting with new skin lesions as late detection can have severe implications.

Specialisation in allied health

This chapter explores the development of podiatric surgery as a state-registered allied health specialisation, and the negotiations with the state and the medical profession that shaped it. Few allied health professions have successfully achieved recognised specialisms. The medical profession particularly and the nursing profession to a lesser extent have both been successful in achieving internal divisions of labour through state-recognised specialisations. While many allied health professions recognise 'special interests' and endorse specialist areas of practice, few of these specialisms are formally recognised by the state or attract a higher level of professional recognition through higher roles and reimbursement. The two notable exceptions to this are the practice of psychology and podiatry.

Prescribing, Supplying, and Administering Medicines. A Contemporary Review of Podiatric Surgery in the United Kingdom

Background. In the United Kingdom (UK) podiatrists are able to access ‘prescription only’ medicines via a specific but narrow range of legally mandated mechanisms. Data on access is also recorded by many podiatrists, especially podiatric surgeons, via a tailored data base developed within the College of Podiatry, known as PASCOM 10.Methods. The PASCOM 10 system was accessed to generate reports for the 2019 calendar year relating to podiatric surgery. The following reports were requested; Procedures, Fixations, Anaesthesia, Demographics, Medications, Post Treatment Sequalae, Patient Satisfaction (PSQ-10), Manchester Oxford Foot/Ankle Questionnaire (MOXFQ), Providers, and Referrals.Results. In 2019 there were 11,189 admissions for podiatric surgery in England recorded on the PASCOM 10 database. 103 surgery centres contributed data resulting in 18,497 procedures. Care was primarily offered in NHS settings accounting for 91% of activity, 94% of these procedures were performed under a local anaesthetic block. 18,576 medicines were supplied, administered, or prescribed from a list of 70 individual items. 29% of all medicines were prescribed by a podiatrist. Controlled drugs (CD) accounted for 28.7 percent of all recorded medicines. Conclusions. Using the PASCOM 10 database, it has been possible to identify an emerging trend in the methods of access to POM medicines by podiatrists, which appears to signal a shift in favour of independent prescribing and with that, a need for better access to controlled drugs to manage acute post-operative pain.

Augmented Reality in the Formation of Minimal Incision Podiatric Surgery.

BACKGROUND: This project shows that the use of augmented reality (AR) technology in the study of podiatric surgery has a positive impact on student outcomes. AR technology can help to enrich the information that provides elements such as X-rays or other diagnostic tools.METHODS : A didactic material with augmented reality was created through the use of markers for the course subjects of Surgical Techniques II, e.g., the topic of hallux valgus surgery, and was compared with the didactic material for 5th metatarsal surgery using PowerPoint and video. The comparison was assessed by a validated questionnaire after providing 2 hours of teaching for each of the subjects to 80 students in a master of surgery program during the 2013-2017 academic years.RESULTS: Analysis of the components of the questionnaire showed that component 1. training, attention and motivation; component 2. freelance work; and component 4. 3D compression were statistically significant at p < 0.05. However, component 3, which compared the technologies used with cadaveric material, was not statistically significant regarding any of its items.CONCLUSION: The current study shows that using augmented reality technology for the study of minimally invasive surgery of the foot increases the attention, the motivation and therefore the learning of the students, in addition to providing three-dimensional images of the surgical movements that are more accurate regarding reality.

Physician expert in diabetes is the natural team leader for managing diabetic patients with foot complications. A position statement of the Italian Diabetic Foot Study Group

Diabetic Foot Syndrome (DFS) is a complex disease to be managed by a Multi Disciplinary Team (MDT). Nevertheless, a Team Leader (TL) should be designated to collaborate with members of the MDT in a patient-orientated approach. A TL should know and manage diabetes, related complications and comorbidities. The TL should have deep knowledge of peripheral neuropathy and arterial disease and be able to diagnose and manage foot infections, including prompt surgical treatment when needed. In Italy, after the pioneering phase in which diabetologists began managing medical and surgical aspects of DFS to fill unmet needs, nowadays there is a network of Diabetic Foot (DF) clinics managed by diabetologists. Italy is one of the countries belonging to Organization for Economic Cooperation and Development (OECD) with the lowest amputation rate in diabetic patients. In addition to the special attention to the care of diabetes, the unique expertise of diabetologists involved in DF management may have been a contributing factor. They all share a “patient centered model” of care mainly related to their internal medicine background and have skills in podiatric surgery to manage the specific needs of DF patients with acute or chronic conditions in a timely manner. In Italy, specific training courses and university master programs have been developed in recent years, to prepare internists (diabetologists/endocrinologists) to become TL’s. This has allowed DF care to move from the initial pioneering phase to a more structured phase, with the creation of specific pathways and roles. KEY WORDS diabetes; diabetic foot; multidisciplinary Team; Team Leader

Design of a Three-Dimensional–Printed Surgical Glove for Minimal-Incision Podiatric Surgery

Background: Precision in minimal-incision surgery allows surgeons to achieve accurate osteotomies and patients to avoid risks. Herein, a surgical guide for the foot is designed and validated in vitro using resin foot models for hallux abducto valgus surgery. Methods: Three individuals with different experience levels (an undergraduate student, a master's student, and an experienced podiatric physician) performed an Akin osteotomy, a Reverdin osteotomy, and a basal osteotomy of the first metatarsal. Results: The average measurements of each osteotomy and the angle of the basal osteotomy do not reveal significant differences among the three surgeons. A shorter deviation from the planned measurements has been observed in variables corresponding to the Akin osteotomy (the maximum deviation in the measurement of the distance from the proximal medial end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.67 mm, and the maximum deviation from the proximal lateral end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.00 mm). As for the Reverdin osteotomies, the maximum deviations in the measurement of the distance from the proximal medial end of the osteotomy to the first metatarsophalangeal joint interline were 3.60 and 3.53 mm in the expert and undergraduate surgeons, respectively. All of the osteotomies were precise among the groups, reducing the learning curve to the maximum. Conclusions: The three-dimensional–printed prototype has been proven effective in guiding surgeons to perform different types of osteotomies. Minimal deviations from the predefined osteotomies were found among the three surgeons.