Surgical footwear: a survey of prescribing consultants

Cross-sectional survey of orthotic service provision in the UK: does where you live affect the service you receive?

OBJECTIVE

To investigate the quantity and quality of orthotic service provision within the UK.

DESIGN

Cross-sectional survey obtained through freedom of information request in 2017.

SETTING

National Health Service (NHS) Trusts/Health Boards (HBs) across the UK.

MAIN OUTCOME MEASURES

Descriptive statistics of survey results, including information related to finance, volume of appointments, patients and orthotic products, waiting times, staffing, complaints, outcome measures and key performance indicators.

RESULTS

Responses were received from 61% (119/196) of contacted Trusts/HBs; 86% response rate from Scotland (12/14) and Wales (6/7), 60% (3/5) from Northern Ireland and 58% (98/170) from England. An inhouse service was provided by 32% (35/110) of responses and 68% (74/110) were funded by a block contract. Long waiting times for appointments and lead times for footwear/orthoses, and large variations in patient entitlements for orthotic products across Trusts/HBs were evident. Variations in the length of appointment times were also evident between regions of the UK and between contracted and inhouse services, with all appointment times relatively short. There was evidence of improvements in service provision; ability for direct general practitioner referral and orthotic services included within multidisciplinary clinics. However, this was not found in all Trusts/HBs.

CONCLUSIONS

The aim to provide a complete UK picture of orthotic service provision was hindered by the low response rate and limited information provided in some responses, with greater ability of Trusts/HBs to answer questions related to quantity of service than those that reflect quality. However, results highlight the large discrepancies in service provision between Trusts/HBs, the gaps in data capture and the need for the UK NHS to establish appropriate processes to record the quantity and quality of orthotic service provision. In addition to standardising appointment times across the NHS, guidelines on product entitlements for patients and their lead times should be prescribed to promote equity.

Effectiveness of the reverse camber shoe in postoperative hallux valgus surgery

The reverse camber shoe (RCS) is commonly used for forefoot off-loading during mobilization after forefoot surgery. However, patient satisfaction and compliance may be affected because of the altered gait pattern that is conferred. The aim of this study was to investigate the patient-related factors associated with the compliance in the use of this device. The authors retrospectively reviewed a single surgeon series of 64 patients who underwent forefoot surgery and who were subsequently rehabilitated with early mobilization using the RCS. Data on patient age, arthritic comorbidities, adaptation to device, and symptoms during use were collected via a standardized postal questionnaire. In all, 39 patients complied with the use of the RCS for 8 weeks (group A), whereas 11 patients managed it for less than 6 weeks (group C). Also, 14 patients used the shoe for more than 6 weeks but less than 8 weeks (group B). The authors found that compliance in the use of the RCS is lower in older patients following forefoot surgery. This may be related to poor adaptation in the presence of preexisting arthritis.

Technical evaluation of a CAD system for orthopaedic shoe-upper design

Computer aided design is now employed routinely in the volume shoe trade. New styles are developed on a three-dimensional image of the last followed by automated pattern generation and engineering. It is suggested that such systems could be useful in the orthopaedic footwear industry although the different requirements for these bespoke products need careful consideration. A clinical trial has been conducted on the Shoemaster (Clarks Shoes) upper design system both to assess its technical capabilities and to consider its role in improvement of service and cosmetic appearance. This particular system works throughout on a three-dimensional representation of the shoe last, which offers particular advantages for integration with shape capture and reproduction. The report concentrates on the technical evaluation to assess (a) its ability to work with unusual last shapes dictated by medical requirements and (b) its potential for integration into a complete computer system for design of both shoe lasts and shoe uppers. The trial indicates that this particular system is promising in both respects.