A Spoonful of Insulin Helps the Sugar Go Down……..

Diabetes UK, through there website, suggest that that there are 4.6 million people living with Diabetes in the UK today, and that by 2025, this will have risen to 5 million, despite advances in detection, medication, and a wider understanding about lifestyle and diet. 10% of this number have Type 1 diabetes, which is a lifelong condition that impacts upon the heart, eyes, kidneys and feet, and the remaining 90% have Type 2, which has very similar impact upon the body, but which more often occurs in later life.

Diabetes is a condition that exists because the levels of glucose in the bloodstream become dangerously high, all due to the bodies inability to create insulin, which assists in allowing this glucose to enter our bloodstream and be converted into energy. Type 2 Diabetes is often associated with poor diet or lifestyle, whereas there is little known about the causes of Type 1.

The reason Orthotists are interested in Diabetes, is that one of the key areas where the impact of the condition can be severe, is in the foot, and this is something that really should not be overlooked. A key feature of Diabetes is that cuts and wounds don’t heal as well or as quickly in a sufferer, and thus the foot, which is usually tucked away into socks and footwear, becomes increasingly vulnerable. Another symptom, for want of a better word, of diabetes, is that certain parts of the body, usually at the extremities such as the fingers or toes, begin to have reduced sensation or feeling, and this is called ‘Peripheral Neuropathy’. If you experience this, then it is easier to harm the foot, and not realise it quickly enough to prevent any damage. Ben Yates (2009) suggests that this peripheral neuropathy leaves diabetics at a greater risk of developing an ulcer, and sadly, he also argues that this increases the chances of reduced mobility, poor life quality and even amputation.

This is all quite scary, but I guess that this is where the Orthotist comes into the equation. The Orthotist will be able to identify risk at the earliest stages, will work with the patient to develop an appropriate prevention strategy, develop an integrated care plan if appropriate, and then refer to other clinicians if necessary, with the aim of maintaining foot health and reducing the risks that may ultimately cause problems into the future. Some of the challenges around a diabetic foot can be biomechanical, and as this is something I’ve discussed a great deal in this blog already, I won’t go on; but, it is important that the diabetic gets assessed by an Orthotist significantly early enough, in order that any issues with gait for example, are managed before they go on to be a bigger problem. The Orthotist is also the most appropriate clinician to advise on footwear, and whilst this may sound a little odd, they are in the best position to advise where an individual requires support, and as importantly, where pressure may become an issue. Appropriate footwear, including socks and hosiery for example, can make the difference between developing an ulcer or not, and where ulceration is already a factor, it is important to understand how to manage this for the best.

In truth, the diabetic patient will probably need the specialist intervention of several clinical experts, but the key message here, is that the Orthotist is an important part of this team, and should be one of the first people to intervene, if mobility is to be maintained, pain reduced, risk to the foot minimised, and a clear pathway established moving forwards, that will enable the diabetic patient to maintain quality of life, and reduce the chances of more severe treatments.

You’ve Got To Be In It To Win It………

One question we get asked a lot, is why there is need for private provision for such things as Orthotics, when we have such a wonderful National Health Service here in the UK. This is a fantastic question, and one that can be answered in a number of ways. Firstly, there is the small matter of demand and supply. Just as with Opticians, Dentists, Physiotherapists, Surgeons, Audiologists etc etc, a market has developed for people wanting a service that offers the individual what they specifically want, be that a shorter waiting time, a more flexible appointment system, or even a greater level of choice with devices for example. This is certainly true of all of the areas mentioned here, and in many other areas of healthcare too. Another reason why private provision in so many areas is growing, is because of something known colloquially as the ‘Postcode Lottery’, which in short, means that there is not an equal level of service throughout the NHS. It has been believed for some considerable time that this lottery exists, and that the level of care you will receive would depend significantly upon where in the country you lived. This is clearly not fair, and has inevitably led to an increase in the need for alternative services in certain places. The reasons for the so-called lottery are varied, and can range from finance to geography; however the outcome is the same.

In a departure from my fairly ‘light-hearted’ approach to all things Orthotics, this month I want to highlight a study that has been conducted by a team of professionals from Staffordshire University, the authors of which are Chockalingam, N,  Eddison, N, and Healy, A (2018). This paper has been published in the British Medical Journal (BMJ) as part of their Open Access journal; however, the British Association of Prosthetists and Orthotists (BAPO), have provided a very concise, yet accurate synopsis of this study, and I have placed this here for your information. I don’t need to say much more about this topic, as this piece sums up the problem quite succinctly.

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Postcode Lottery for NHS orthotics patients

Specialist orthotics care for patients with mobility issues varies significantly depending on where they live, new research by Staffordshire University reveals.
The findings, published on BMJ Open, have uncovered major differences across orthotics services at various NHS trusts and health boards.
Problems within orthotic service provision in the UK have been the focus of a number of reports by the NHS and other organisations. An NHS report from 2014 highlighted that many patients experienced long waiting times which could lead to the development of secondary health complications.

Professor Chockalingam and colleagues at Staffordshire University based their research on Freedom of Information (FOI) requests sent to all NHS trusts and Health Boards in the UK. The survey scrutinises information on Finance, Service Provision, Staffing, Complaints, and Outcome measures and key performance indicators (KPIs).

The results highlight large variances in the length of appointments, appointment waiting times, product entitlements for patients, and product lead times. Certain geographical areas were found to provide shorter waiting times and wider access to assistive devices. The findings also reflect there is more information available on the quantity of service above the quality of service.

The findings showed that:
  • average and maximum waiting times for adult appointments were 7 and 34 weeks, respectively.
  • Scotland seems to fair better in all of the reported measures. Patients in Scotland have longer appointment times and the average waiting times are lower.
  • some Trusts are not fully accommodating the needs of children
Nachiappan Chockalingam, Professor of Clinical Biomechanics at Staffordshire University, explained: “Within the NHS, the Orthotics Service is poorly understood and low in priority lists. Therefore, it is essential to evaluate the current state of provision to ensure that services are capable of meeting future demands.

“In 2011, a report estimated there were 2m orthotics users in England and assistive devices including wrist splints, custom footwear, foot and ankle support, back and neck braces are needed to alleviate pain, help patients recovering from injury and those with chronic conditions.

“In future, there will be an increased demand for orthotics services because of the projected population growth, the aging population and the rising prevalence of obesity, diabetes, cardiovascular and peripheral vascular diseases.”

Dr Aoife Healy who co-authored this study added: “Our results highlight that some of the Trusts appeared to not accommodate the needs of children fully. Waiting times of 20 weeks for routine and 8.2 weeks for urgent appointments are unacceptable”.

The researchers hope that these findings will prompt the NHS to instigate its own evaluation of services across the country. Ms Lynne Rowley, Chair of British Association of Prosthetists and Orthotists (BAPO) said: “We welcome this study, which clearly showcases the inequalities across orthotic service provision in the UK. BAPO has been aware of this issue and has been working with NHS England. However, this study is timely and provides a push in the right direction.”

However, the combination of the number of Trusts and Health Boards who declined to reply to the FOI request and those who replied with limited information hindered the team’s ability to provide a national picture of Orthotic Service provision.
Professor Chockalingam added: “The UK NHS needs to establish appropriate processes to record the quality of service provision since this will enable improvements in clinical management and ensure good value for money.”
Read the full paper http://dx.doi.org/10.1136/bmjopen-2018-028186 here.

This is by no means an apologetic piece, but one in which I hope I have prompted thoughts about the possible causes of waiting times, the limits placed upon types or numbers of devices available, even the availability of the service at all, and so on. As I have stated several times in this blog over the last 12 months or more, the NHS in the UK is fabulous, and a model for the rest of the civilised world. What it isn’t however is perfect, and certainly not in our very imperfect society currently. Private practice exists to fill gaps for those who increasingly recognise its limitations, as they have with eye tests, dentistry etc for some years now. If you can’t access private healthcare for whatever reason however, REMEMBER, however flawed it may be at times, the NHS is still there for you, and long may this be the case. 

At some point in every person’s life, you will need an assisted medical device – whether it’s your glasses, your contacts, or as you age and you have a hip replacement or a knee replacement or a pacemaker. The prosthetic generation is all around us (Aimee Mullins).

As Aimee Mullins so eloquently suggests, prosthetics are all around us, and are now commonplace, whether as a result of replacement surgery, or from spectacles, hearing aids, false teeth, and the list goes on. This is quite an interesting quote from Aimee however, as she is one of the most famous bilateral amputees in the USA right now, having had both her legs amputated at a young age as a result of a severe medical condition. What I want to examine very briefly in this blog, is the role of the clinician in the care provided to both upper and lower limb amputees.

It is now the case in the UK at least, that prosthetics and orthotics are taught and assessed together. All people going through the education and training process, which as mentioned in a previous blog is at graduate level, will dual qualify, and will then be able to practice in either, or both disciplines. There is clearly a reason for this cross-over, and whilst the two fields may seem unconnected, this could not be further from the truth.

I guess I should begin by outlining precisely what prosthetics are, particularly as the opening quote may have already caused some confusion. Put simply, a prothesis is a device that replaces a missing body part. This can of course be any body part, hence the mention of false teeth, as these are strictly speaking, prosthetics. In the context of this blog however, we are referring to limbs, as opposed to more general body parts.

Prosthetic limbs can be necessary following congenital loss (at birth), loss due to vascular issues, as a result of diabetes, or as a result of trauma. Amputees have become more visible in recent years in the UK as a result of the work of organisations such as Help for Heroes, and the work they do with military personnel, who have lost limbs in the line of duty. Whilst we see and hear more about prosthetic legs, there are obviously a whole range for the upper body too.

Prosthetic limbs, whilst doing fundamentally the same job that they have always done, are now incredibly technologically advanced, and there has been a distinct shift in the attitudes towards them, both by wearers, who often used to feel as if a prosthetic limb was something they had to hide or disguise, and indeed the general public, who now see them as ‘normal’. In fact, many amputees are now more than happy to display their prosthesis, with all its technology on show, as opposed to hiding them or feeling shame. This doesn’t of course diminish the seriousness and trauma of having to cope with amputation, or indeed with having to learn to use such an alien device.

I’ve already noted that most Orthotists are qualified Prosthetists, and vice versa, and whilst it may not be immediately obvious how their work is so similar, the answer of course, as mentioned so many times in previous blogs, is biomechanics. The Orthotist manages existing limbs, whilst the Prosthetist manages replacements, but biomechanics is fundamental in both areas. It is also true that the Orthotist will very possibly still be called upon to provide treatment for the amputee in so many cases. For example, whilst it is the job of the Orthotist to manage the diabetic foot, largely in order to prevent amputation, if this does become necessary however, they will still work with the patient to manage their residual limb, as it is often the case that there will only be a partial amputation, and the gait and biomechanics will then change significantly.

Orthotists also work with amputees, as they very often have particular issues with the biomechanics of there remaining limb. Take for example someone who has lost their right leg. Their left leg, foot and ankle, will have different forces placed upon them, and they will require orthotic intervention, to reduce pain, increase stability, and maximise mobility in this existing limb, and this is doubly important as they then handle to tough task of using a prothesis.

I appreciate that talk of amputation and prosthetic limbs is not always cheery, and many are living with this trauma each day. No matter how ‘trendy’ and technologically advanced a prosthetic limb can be, it is still a replacement, and we should not forget the pain and mental anguish that most amputees experience as they undergo their treatment, and most would turn back the clocks where possible, in order to prevent such life changing events. Orthotists work tirelessly to manage limbs, and this is often in order to prevent amputation, be this with a diabetic, a heavy smoker, people living with disorders or disease, and they have an incredible success rate. Rest assured however, that if amputation is the only option available, the Prosthetist and Orthotist will still be there to minimise pain, maximise stability, and promote increased mobility.

The best thing for a wonky leg, is a beer mat, preferably with the glass of beer still on it….. (anon)

In all seriousness, there are many people experiencing back, hip and knee pain, for whom, a slightly more sophisticated version of the beer mat, may indeed be the answer. A larger number of people than you might imagine, experience significant, often debilitating pain, as a result of a leg length discrepancy. This, quite simply, is a difference in the length of the left and right leg, and it can be the result of a number of issues. As usual in this blog, I will examine each of these in turn, and then offer an explanation as to how an Orthotist can be of assistance in reducing pain, increasing stability and mobility, and helping us to live a happier and more independent life.

The first cause of a leg length discrepancy (LLD), can be a congenital issue that manifests itself during childhood. This can be the result of several conditions, but can arise at different ages, be of varying degrees of severity, and can be treated in different ways. One common cause of an LLD in a child, is where growth rates are not consistent in both limbs. This can be treated by attaching a plate, during surgery, to either the femur, the tibia, or on rare occasions both, on one leg, to prevent growth, in order to let the other limb ‘catch up’, for want of a better phrase. This is obviously quite a severe case, and is not the norm. What is more common however, is that someone goes through childhood with a slight LLD, that is largely unnoticed as at that age, we are less likely to see significant pain or reduced mobility. The problems become more acute and noticeable in older age however, and it is not uncommon for someone to present with pain, only to discover that this LLD has been present for years, prior to becoming something that needs to be treated.

The second cause of LLD, is trauma. This can be something such as someone suffering an impact injury whilst playing sport, or in a car accident, or even during a trip or fall on ice or snow for example. Again, if this happens in someone young and fit, then it may not be picked up as a significant issue at first, but may then manifest itself as a severe problem later in life. This is very often the case in people who play sport, particularly at a high or intense level. We are starting to see more of these issues in runners for example, as more and more people take up marathon running or take part in triathlons. Pain during training is seen as ‘the norm’ for many, but may ultimately be the product of an undiagnosed and intreated LLD, which may see the end of a career at worst, or a reduction in performance at best.

As more people are now electing to have replacement surgery, referring particularly to knee and hip replacements here, there are a whole new group presenting with pain, following their surgery, and this is also very often a result of an LLD, caused potentially by the surgery itself. It’s not impossible to see how this may happen, once the limbs being replaced are manipulated to permit the replacement, resulting in a change to the length of one leg and not the other.

Regardless of the cause of the LLD, the problems are the result of an asymmetrical gait, which then causes the sufferer to change their posture, or how they manage walking more generally. It’s well known , that something like stubbing a big toe, can the lead to temporary pain elsewhere in the body, as the change in the way we walk as a result of the pain in the toe, causes pain further up the skeleton, either in the knee, the hip, the back, or even as far up as the neck. So, imagine this on a much more permanent basis. The discrepancy doesn’t need to be large to cause pain, and it doesn’t necessarily follow that the greater the difference, the more intense the pain.

The key message here however, is that pain suffered as a result of an LLD, can often be easily sorted, and of course, the earlier it is detected, the easier it is to fix, and the better the results are likely to be. I started this piece with the wonky table leg analogy, and as simple as this may sound, managing pain and increasing stability in someone with an LLD, is very much the same solution. Depending upon the severity of the discrepancy, a simple heel raise can either be worn inside footwear, or an external raise can be added to shoes to compensate for the length difference. There is a warning here, as there is a bit more science to this than simply adding bits until it feels about right. This is a considerable biomechanical issue, and an Orthotist is best placed to assess the discrepancy, and ultimately to then prescribe an appropriate course of action to rectify the problem. This is not something that will usually ‘mend’ itself in time, unless in young children of course, and the raise may become a permanent feature, albeit one that reduces or even removes the pain, makes you more stable, and increases your mobility, and your confidence whilst walking.

If you are experiencing knee, hip, back or neck pain, then a trip to your Orthotist may just be the start of your journey to a happier life, and with such a simple solution to boot.

Some Things Are Better Left On The Shelf…..

In these days of convenience and on-line shopping, we are all often tempted into a purchase that we wouldn’t necessarily otherwise make had we more time, and yes, more money. Finding yourself in pain, turning to the famous on-line search engine for a speedy diagnosis, and then purchasing something that can be delivered the next morning is now far too common. This is also causing problems for many, as firstly, our trained, experienced and registered medics and clinicians, can never be replaced by the internet, largely, as it can only provide you with stock answers to a series of set questions, and this is not how a face-to-face consultation works in the real world, or at least it shouldn’t. This problem is exasperated by TV and social media advertising, which tempt us with the perfect cure for just about anything, for a few pounds and available at the click of a mouse or on your mobile phone. It was only the other day, when I saw a TV advertisement for a device which claimed to ‘cure’ plantar fasciitis, back pain, and basically have you walking miles ‘just like you used to’. I obviously cannot categorically state that this device has no benefit to any of these, or other conditions, but the chances are slim at best.

The same is now true with orthotics. As these are becoming more ‘common’ or well known, there are adverts out there for a whole range of different types, all of which claim to solve a problem. My first question has to be however…….. DO YOU KNOW WHAT YOUR ‘PROBLEM’ IS? Unless you have been examined by a qualified Orthotist, how do you actually know what the problem is? To purchase something, whether it costs £5 or £5000, without knowing what its is you are trying to achieve is frankly ridiculous. If your car suddenly developed a fault, you wouldn’t automatically go out and buy Big End Bearings on the off chance that this might solve the problem would you. To rush out and buy an ankle brace because of pain in this region would be just as random.

There are a whole range of insoles available ‘off the shelf’, ranging from simple foam, to gel, to plastic and beyond. As previously noted, the fundamental problem here, is that you have no way of knowing if these are going to play any part in reducing pain or increasing mobility. They may even cause a bigger issue elsewhere in the body. The worst case scenario, is that they change your posture, and what may have been pain in the foot or ankle, can suddenly become a serious back problem, or neck, or hips and so on – I’m sure you get the picture. The other concern here, is that using such a stock item, may also inadvertently mask a more serious issue somewhere else, that may go further undetected.

The issue isn’t just insoles here either, as there are a whole range of ‘braces’ or tube-style bandages that cause the same concerns for healthcare professionals. Bracing your knee for example, may provide immediate relief, but if this is masking a more significant problem elsewhere, then the problem is not being solved, but is potentially being worsened.

Whilst these items may well be cheaper, they are often a false economy, as they will end up either not working at all, or for very long if they do. I hear the phrase ‘buy cheap, buy twice’ so often these days, and this is so true in this case. There is no better course of action than getting checked out by a qualified, experienced, and HCPC registered Orthotist, be this through the NHS or privately. I’ve already used the broken down car analogy, and here it is again – this is the same as taking your poorly car to a reputable establishment to have it correctly diagnosed and repaired, as this will be the only way that you will have peace of mind driving it in the future.

So, to manage pain and increase your mobility, book an appointment today to help you on the road to getting the right treatment, at the right cost, and with the right devices where required.

There Are Times When It Pays To Be F.A.S.T, Not Loose………

The Stroke Association believe that there are in excess of 100,000 Strokes happen in The UK each year, and that there are 1.2 million Stroke survivors living in the UK today. Stroke happens when the blood supply is cut off to a part of the brain, thus killing brain cells. This can of course, change the way our body works, and alter the way we act and think. There are TWO different kinds of stroke:

Ischaemic strokes occurs when blood clots or fatty deposits for example, create a blockage to certain parts of the brain. The impact of such an event will obviously vary dependant upon which part of the brain is affected.

Haemorrhagic strokes occur when blood vessels burst within the brain, or on the surface of the brain.

The Stroke Association state that 85% of strokes are Ischaemic, but also that 10% of sufferers of a Haemorragic stroke will die before reaching the hospital. One of the key factors in reducing the numbers of stroke victims, is to primarily make people aware of the medical and lifestyle triggers that increase the likelihood of becoming a victim, and these include such things as reducing alcohol consumption, increasing exercise and stopping smoking. Equally as important, is to get the message out highlighting the warning signs that someone may be having a stroke, and this is where F.A.S.T comes in:

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The Stroke Association website is full of incredibly useful and informative facts about prevention, detection and rehabilitation, and this can be accessed at:

http://www.stroke.org.uk

I’ve already noted that thee are 1.2 million stroke survivors in the UK, and some of these will go on to something close to full recovery, and with a bespoke rehabilitation programme, will be able to return to something akin to a ‘normal’ life. For many however, the aftermath of a stroke leaves them with significant mobility, stability and pain issues. This is, like in other issues of this blog where we examine various conditions, where the field of Orthotics can come in to assist not only in recovery, but also in rehab and part of the longer term plan to increase movement and maintain independence. If I can refer you back to my previous piece on foot drop, which is very common in stroke survivors…..:

Foot drop is a condition caused by weakness or paralysis of the muscles involved in the operation of lifting the front part of the foot. This is a particular issue when we walk, as this can lead to excessive tripping or falling, or pain caused as a result of the sufferer deliberately altering their gait pattern to avoid this. One common cause of foot drop, is an interruption of the signals from the brain to the peroneal nerve, and this is not unusual in people who have suffered a stroke.
There are several ways that this can be managed, but one way is with a merging of orthotic technology with electrical stimulation. This doesn’t simply brace the limb to improve mobility, but instead using Myo-orthotic technology, restores the functionality of the impaired limb by recreating a natural nerve and muscle response producing only a slight tingling. The WalkAide FES system is worn on the skin, removing the need for implant surgery. This sounds like it could be an ordeal, but this really is modern technology doing its bit towards improving mobility, without any kind of invasive treatment, and with only a small cuff needing to be worn around the leg.
It may be that the orthotist would suggest a more rigid brace, such as a Carbon Fibre AFO (Ankle Foot Orthosis). Carbon fibre is an incredibly light, durable and hypoallergenic material. A carbon fibre AFO can provide a decrease in bulk and an increase in activity due to it’s ‘spring’ effect offering smoother and more natural gait. This option clearly doesn’t introduce the need for electronic stimulation, and whilst it might be a little more visible than the FES unit, is not bulky or unwieldy.
Some sufferers may find that a SAFO (Silicone Ankle Foot Orthosis) is more appropriate. This is a total contact silicone orthosis which incorporates the foot and ankle, and works by lifting the foot from above, as opposed to pushing from underneath as per traditional rigid braces. The SAFO gives support without interfering with normal biomechanics. This silicon brace is obviously less rigid, and can for some, be the perfect solution to the tripping issue.

So, if you are  stroke survivor and you feel you could benefit from speaking to your Orthotist, then today is a good day to make that call.

 

 

You don’t need to be Mad (Max) to wear a brace……

In fact, for the many thousands of people around the world suffering the effects of Polio, or Post Polio Syndrome (more on this later), you’d perhaps be mad not to though.

Polio, or Poliomyelitis to give it its correct name, is a disease, that whilst having been eradicated in Europe in the early 2000s, still causes pain and is massively life-changing for so many even 17 years on. Polio is a very infectious disease, and was primarily contracted orally, and in years gone by, swimming pools were often blamed for predominantly children contracting it. In up to 70% of cases, there would be no symptoms beyond an extreme cold or flu, or problems with the stomach. In a significant percentage however, the symptoms were severe, and caused a whole range of issues. There was a significant difference between what was known as ‘abortive Poliomyelitis’, where the symptoms, whilst debilitating didn’t lead to paralysis, and ‘paralytic Poliomyelitis’, where as the name suggests, paralysis was a feature. Most often, this was spinal paralysis, and was caused by a viral invasion of the motor neurones in the spinal column. Despite the severity in a large number of cases, many of those who suffered, even badly, as a child, recovered in the main to enter adulthood without the disease.

It is important to note that there is no cure for Polio, and whilst there is a very successful vaccination programme in place in many parts of the world, this isn’t the case globally. The World Health Organisation were hoping for global eradication of the disease by now, we are not quite there yet. As recently as 2015 in the Ukraine, there were 2 new cases of the disease.

The fact that Polio is something of a historic disease, does not mean that we are free from the ‘aftermath’ all these years on. There are believed to be in excess of 100,000 sufferers in the UK alone of a viral infection known as Post Polio Syndrome (PPS). As the name suggests, this is something that arises in adults, usually about 15 to 30 years after they first had polio, and the impact upon health, mobility and lifestyle is hugely significant, as this also has no cure, and the effects of it simply have to be managed, and by this, I by no means suggest that the management of it is simple in any way, shape or form.

Because the vaccination programme didn’t really kick in until the mid 1950s and early 1960s, we still have a large number of PPS sufferers living today, and many have these have significant mobility issues. One of the problems with PPS, is that it is quite difficult to diagnose, as it shares many of its symptoms with Chronic Fatigue Syndrome (CFS), and also in fact is often simply put down to signs of ageing. Unlike CFS however, PPS is progressive, and thus often results in significant loss of muscle strength. Diagnosis can now be done using electromyography, or an EMG as it is more commonly known, or MRI in certain cases. The really bad news for PPS sufferers, is that there is no reversive therapy, thus once diagnosed, it is all about treatment and management of the condition, as opposed to trying to get ‘better’ from it.

This is where Orthotic intervention comes in here. I used the image from Mad Max at the head of this post, as it shows the Max character wearing some kind of futuristic leg brace – futuristic for when the film was made I would hasten to add, and in fact, the range of Knee, Ankle Foot Orthoses (KAFO) today, is far more technologically advanced that anything available in the dystopian world of the mid 21st century envisaged by its makers in 1979! As with many of the conditions I have explored in this blog, the treatment is entirely bespoke and is specific to the individual, so there is definitely no single approach to how PPS is managed in any given person. Ankle Foot Orthoses (AFO) and KAFOs are designed to really do several jobs, and these include the desire to maximise energy efficiency, so really to ensure that any energy used by the wearer has the best outcome, to reduce pain, and of course to protect the limb and the joints from any unexpected or unusual forces, which actually we all encounter naturally as we go about our daily lives, but which have to be managed in cases such as PPS.

The great news, is that technological advances have meant that KAFOs and AFOs are now far stronger and lighter than ever before. Materials such as titanium and carbon fibre are now common in the manufacture of these Orthoses, where callipers used to be made of leather and steel, which were themselves very heavy and cumbersome. Orthotic insoles (FFOs), as well as shoe design and manufacture, all mean that now being prescribed an KAFO, with FFOs, and needing shoes wide and deep enough to accommodate all of this, is no longer an issue of being subject to instruments akin to those used in torture, and having to say farewell to any semblance of style.

Some PPS sufferers reject the PPS label, and prefer to be recognised as still suffering from the Polio that affected them as children or young adults, and there is also some resistance to orthotic intervention in their treatment, as they see this as ‘giving in’. This couldn’t be further from the truth, as this is about maximising mobility and stability, maintaining the highest level of independence, and enhancing lifestyle and making the most of what we can. We haven’t quite reached the dystopian nightmare offered in Mad Max, and even in changing times, we still have so much to enjoy, and the right Orthotics, prescribed by a qualified, experienced and HCPC registered Orthotist, will help you to do this.

If you think that you may be suffering from PPS, or you are experiencing mobility issues of any kind, make that appointment and see your Orthotist as soon as possible, because contrary to the Mad Max title track, we DO need another hero, and it might just be you, and like Max himself, you won’t be much use if you are not wearing your Orthotics!!

I Believe the Children are our Future…….

As the song goes, ‘Treat them well and let them lead the way…….’ (Masser and Creed, 1977). Sadly, even in the 21st Century, with all the medical and technological advances made in the last 100 years, there are still many circumstances in which children are being born with issues that will impact upon their lives – some through childhood, and some well beyond into their adult lives. It is the worst and best part of being in any kind of healthcare or medical profession, in that you see the pain and anguish of a poorly child, but you also get to experience the absolute elation that is assisting a child to overcome some of the real issues that they face every day of their young lives. There are, of course, many such illnesses and conditions that can effect children, and it would be impossible for me to tackle all of these in this forum, but I do want to examine just a few of the more frequent cases here, and then to look at just how an orthotist can assist in reducing pain, increasing mobility, and providing the stability for a growing child as they go forward into adulthood.

One of the better know conditions is Cerebral Palsy (CP), which literally means paralysis of or in the brain. This is damage that will not be cured, and is therefore persistent. As Hinchcliffe (2003) notes however, good positioning and handling can improve some of the issues related to posture and movement in children with CP, and conversely, poor handling can worsen movement for example. Often, children with CP have high muscle tone, which in basic terms means that their muscles are tense, and this also in turn prevents muscles from developing normally, which then goes on to cause further problems regarding mobility. CP is a once-only event, and it doesn’t reoccur and is not progressive, thus children who respond well to treatment, can show significant improvement in their stability and mobility, but more on how this can be achieved later. There are several ’causes’ for CP, but in most cases, the cause is not identifiable. Similarly, the problems associated with having CP is not the same for all children. There are often sensory issues, which may include sight, hearing and touch, and one quite common feature, is that the child has an issue with locating their limbs in relation to their bodies, thus becoming increasingly relying upon their sight in order to move around. This is something that has to be seriously considered when treating a child with CP, as you cannot rely upon the presence of touch or sensation, whilst at the same time having to factor in falls and bumps during movement.

Congenital Talipes Equinovarus, or club foot as it is often called, is another issue that manifests itself in babies. The definition of Talipes is quite complex, but put simply, it is where the foot is inclined inwards, axially rotated outwards and pointing downwards. Whilst the condition isn’t painful for babies, if it goes untreated, it becomes very painful for the toddler, and causes significant issues with walking as the child gets older still. Treatment usually involves a level of manipulation of the foot or feet, as in many cases, both feet are affected, and then it is often down to the Orthotist to ensure that the positioning of the feet is correct, in order to ensure a normal gait pattern, and to prevent issues with footwear in later life.

I’ve already examined the issues surrounding hypermobility in a previous blog post, but by way of a reminder…… A large number of children who live with hypermobile joints, experience pain, and can also present with a number of other, seemingly unconnected symptoms. ‘Joint Hypermobility Syndrome’, or sometimes ‘Benign Joint Hypermobility Syndrome’ as it is known, can be associated with joint pain and movement difficulty, but can also be linked to fibromyalgia, anxiety, low blood pressure, and even Urinary Tract Infections. Much of the joint pain happens after engaging in activities, or at the end of the day, and can be present within the hypermobile joint itself, or can manifest itself in other areas. Sometimes, hypermobile joints are susceptible to ‘cracking’ or ‘clicking’, but it is not normal for this to create further damage or to restrict mobility.

The NHS, as always, are fabulous in treating these, and other conditions common in children; The issue however, as in so many cases, is the level of time and funding that is made available through our wonderful health service. Splints prescribed for children with CP for example, may not be the best for their care, and whilst they may provide a level of support, they may not always be the most comfortable to wear, or allow for more everyday childhood activities. Your Orthotist working outside of the NHS has a whole different set of options available for you, but these do obviously come at a cost. These include a variety of FFOs and AFOs, lycra suits, bespoke footwear, and in certain cases, even devices such as the Paediatric F.E.S, which provides active muscle contraction for children with foot drop, not uncommon in CP sufferers.

In short, whilst some of these childhood issues are likely to impact upon their lives into their teens and beyond, the best treatment can certainly work to improve mobility –  often unaided, reduce pain, possibly reduce the need for surgery, and certainly work to improve quality of life. So if your child has any of these issues, then make an appointment to see your Orthotist as soon as possible, as this will certainly count as ‘treating them well’.

Now This Will Definitely Get on your Nerves……

Multiple Sclerosis, or MS as it is more commonly known, is something that affects over 100,000 people in the UK according to the MS Society website. Strangely, MS affects almost 3 times as many women as it does men, and the reason for this is largely unknown. Like so many other conditions and disorders, the symptoms of MS can vary from person to person, and they can also change significantly across a period of time. What isn’t so common however, is that an MS sufferer can begin to experience symptoms long before a diagnosis would be sought. So what precisely is MS?

In the proverbial nutshell, MS is a condition that affects the brain, the Spinal Cord, and the Central Nervous System (CNS). The nerve fibres within the Central Nervous System are protected with a coating called myelin, and this shields the nerves. In someone with MS however, the immune system begins to attack the myelin, mistaking it for a ‘foreign body’ that it needs to fight, as it would with any other disease or illness. This then leaves the nerve fibres unprotected, and often results in lesions that slow down information as it passes through the CNS, and at it’s worst, causes these messages to be stopped completely, thus resulting in the disability or lack of mobility, so often associated with MS. Put in a completely lay-persons terms, if you cut a piece of electrical cable, you will see several wires, all covered with a protective plastic coating – think of this as myelin. Whilst this coating is intact, the electricity flows though the cables safely and without interruption. Cut through these protective inner cables however, and you will create electrical shorts, and at the worst, a complete failure in the power reaching whatever it is you’re trying to use, thus disabling the piece of equipment.

It is impossible to provide a list of symptoms, as this would very much depend upon which part of the CNS is damaged, and as this serves the entire body, it would then be specific to the individual concerned. The symptoms can range from fatigue, to dizziness, to pain, emotional or mental issues, and through to impact upon mobility and speech for example. Symptoms can also change very quickly, even during a single day, someone can relapse or conversely can enter into periods of remission, where the symptoms ease, or change.

A great deal of research is being undertaken to find causes and cures for MS, but this is a lengthy and expensive process, and it is unlikely that there will be any significant breakthrough imminently. It is therefore important, for people diagnosed with MS, which incidentally usually requires an MRI or a Lumbar Puncture, to manage their symptoms in order to minimise pain, and to maximise mobility, particularly through the earlier phases of the condition.

This is where your Orthotist can help. As with so many other issues where mobility is impaired, or where pain resulting from mobility is increased, the Orthotist can conduct a thorough biomechanical assessment, and from this, prescribe the most appropriate course of action. It is important to note at this stage, that this ISN’T just about the feet or insoles! Whilst this may indeed be relevant for some, it’s not going to make much difference if the pain manifests itself in the upper limbs; the arms or shoulders for example. BUT, your Orthotist may still be able to assist in reducing your pain and increasing your range of movement, whilst preventing further damage and maximising stability.

So, if you have been diagnosed with MS, or are suffering symptoms in the stages pre-diagnosis, then it is time to make an appointment to see your Orthotist, as whilst they can’t prevent the onset, ‘treat or cure’ MS, they can assist you with managing your life around the condition.

Ruin A Good Walk? Certainly Not…….

If you play any sport, then it is vital that you maximise stability and mobility, whilst minimising pain, and with many sports, this boils down to ensuring that you have the correct footwear and making sure that it is performing the way it should. In most sports, the shoe itself has a part to play in assisting you to achieve your best, be this a specific sole on a running shoe, a stud on a football boot, or the spikes on a golf shoe; however, the shoe can only ever be part of the process.

If we take the game of golf as our example here, you could own a pair of the best golf shoes available today, and yet the key to ensuring that stability and mobility are maintained, rests primarily with understanding what your foot does in that shoe. If you have existing issues such as Hallux Valgus, or a bunion to you and me, suffer with an arthritic foot, plantar fasciitis, fallen arches, in fact, any number of foot problems, then it is vital that you seek help and advice from a qualified Orthotist at the earliest opportunity, as this can reduce pain, and prevent future deformity or injury. Playing on regardless, will also be doing your game no favours either, as lack of stability and pain resulting from not addressing underlying issues, will only serve to hinder your progress towards the 19thhole!

So, if you play golf, and you’re finding that you are experiencing greater pain, reduced mobility, and are feeling less stable, then book your consultation with an experienced and HCPC registered Orthotist, and let them help you to bring down your handicap!

Bend it Like Baryshnikov……….

More often than we probably imagine, children develop with several joints that are more flexible than others. This is usually called ‘Hypermobility’, and it happens when the connective tissue, which is an integral part of the joint, is more easily stretched than usual. Hypermobility is not always a problem, in fact it is almost necessary for some athletes, gymnasts and dancers, particularly ballet dancers. Children’s joints almost always have a greater range of movement than that we would expect to see in an adult, and this flexibility usually limits with age. Interestingly, girls are usually more prone to Hypermobility than boys too. So if Hypermobility is normal, and even seen as a advantage in some fields, why is it an issue, and why are we discussing it here?

Well, a large number of children who live with hypermobile joints, experience pain, and can also present with a number of other, seemingly unconnected symptoms. ‘Joint Hypermobility Syndrome’, or sometimes ‘Benign Joint Hypermobility Syndrome’ as it is known, can be associated with joint pain and movement difficulty, but can also be linked to fibromyalgia, anxiety, low blood pressure, and even Urinary Tract Infections. Much of the joint pain happens after engaging in activities, or at the end of the day, and can be present within the hypermobile joint itself, or can manifest itself in other areas. Sometimes, hypermobile joints are susceptible to ‘cracking’ or ‘clicking’, but it is not normal for this to create further damage or to restrict mobility.

Hypermobility is often easiest to identify visually in the knee, as increased ligament flexibility in the knee, allows it to ‘hyperextend’, and the child, when stood, has their knee behind the pelvis, if this makes sense. Where this is present, there is an increased likelihood of flat feet (which I wrote about last month), and ankles more susceptible to damage due to the lack of support that hyperextension creates. Kids with Hypermobility, also often have some tighter muscles, and whilst this sounds contradictory, it can often be a product of posture, due to the flexible joints themselves. Take for example, if children sit on a floor with their legs wide apart, sometimes with their spine flexed, then they will experience stiffness and find it difficult to sit with their legs outstretched.

There are a couple of more serious conditions where Hypermobility is present, but this alone is not a specific indicator of Ehlers Danlos Syndrome or Marfan’s Syndrome, and parents should not automatically assume the worst case scenario.

So, how can an Orthotist help a child with Hypermobility? The simple answer is by not attempting to ‘over-brace’ the child. Hypermobile ankles or Hyperextended knees for example, can often be best treated starting at the foot, and this would be with an insole, or sometimes even a heel lift. The key is not to automatically reach for the brace that would hold the joint in a corrected position, as this may then hinder muscle development, which could rectify the problem by itself. Allowing the muscles to develop, will often  bring about reduced flexibility in the affected areas, but if a brace is used, then the muscles might not do their job correctly. Of course, in cases where the flexibility remains, and a Functional Foot Orthosis is not providing the stability required, then of course options such as braces, or boots are available, but the best person to give this advice is your Orthotist.

If you think your child is a little too ‘bendy’ then, it would be a good idea to make an appointment to see an Orthotist sooner rather than later, because whilst it might be the muscles that are developing to tighten the joint, the pain will need to be managed, and the foot and ankle will be held in a corrected position, to allow the muscles to develop as they should. After all, this is what your Orthotist is there for.