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I have high hopes that someone can be my little ray of light on this one! Here's the scenario:
NHS contractors are demanding 'evidence', (although I suspect no matter how much 'evidence' we produce, it will not be enough if it doesn't come from Gordon Browns mouth itself!), to support the treatment of post-op tib post / AAFF patients with custom-made orthoses.
The patients concerned are, generally, all stage II and have had calcaneal osteotomy, tib post repair via FDL transfer and, in some cases, spring ligament repair and are being provided with custom-made orthoses to support the rearfoot in its new position and to reduce the forces put upon the FDL transfer and spring ligament repair, plus preventing further midfoot collapse.
NHS argument says that we cannot give NHS patients different treatment in different locations. At present, if they went to the Orthotists Dept they would get an EVA device made, if they are lucky, from a foam impression, or a simple insole, which, sometimes, will come from a template created from drawing around the persons foot. Therefore, NHS suggesting that we should 'come down' to this level, or no more treatments will be authorised.......unless I can produce the 'evidence'! At this point I readily agree that, if they had the budget, the orthotists would, I'm sure, not be doing this kind of orthotic!
Searched PubMed and there are some promising articles, but none of which I can view without pruchasing them,which I will do, but, in the meantime, is there any body out there who has the research material to hand, magically, that I need? Generally, this would be research looking at the use of this type of orthotic post-op this particular op and why!
Even though I've already done 3 very similar reports on the use of orthoses, still doesn't seem to progress matters......I suspect they are being used to balance one end of someone's wobbly table for all the use they've been!
Re: Post-op orthoses following tib post repair with FDL transfer and calcaneal osteotomy
Quote:
Originally Posted by nicpod1
Hello All!
I have high hopes that someone can be my little ray of light on this one! Here's the scenario:
NHS contractors are demanding 'evidence', (although I suspect no matter how much 'evidence' we produce, it will not be enough if it doesn't come from Gordon Browns mouth itself!), to support the treatment of post-op tib post / AAFF patients with custom-made orthoses.
The patients concerned are, generally, all stage II and have had calcaneal osteotomy, tib post repair via FDL transfer and, in some cases, spring ligament repair and are being provided with custom-made orthoses to support the rearfoot in its new position and to reduce the forces put upon the FDL transfer and spring ligament repair, plus preventing further midfoot collapse.
NHS argument says that we cannot give NHS patients different treatment in different locations. At present, if they went to the Orthotists Dept they would get an EVA device made, if they are lucky, from a foam impression, or a simple insole, which, sometimes, will come from a template created from drawing around the persons foot. Therefore, NHS suggesting that we should 'come down' to this level, or no more treatments will be authorised.......unless I can produce the 'evidence'! At this point I readily agree that, if they had the budget, the orthotists would, I'm sure, not be doing this kind of orthotic!
Searched PubMed and there are some promising articles, but none of which I can view without pruchasing them,which I will do, but, in the meantime, is there any body out there who has the research material to hand, magically, that I need? Generally, this would be research looking at the use of this type of orthotic post-op this particular op and why!
Even though I've already done 3 very similar reports on the use of orthoses, still doesn't seem to progress matters......I suspect they are being used to balance one end of someone's wobbly table for all the use they've been!
Thank you to anyone with any helpful material!
No matter what evidence you do produce, the insurance companies or governmental authorities will want to deny treatment to patients to save themselves money and therefore cost the patient valuable and necessary treatment.
Unfortunately, to my knowledge, there is nothing in the literature regarding post-op flatfoot surgery orthoses. However, there is literature regarding treatment of posterior tibial dysfunction with foot orthoses or braces and this research could be used to establish a meaningful argument that foot orthoses should be used to maintain correction of the foot since no flatfoot surgery is ever perfect. I don't think you will be able to have enough evidence to say what orthosis is the best, whether it is made of polypropylene or EVA or casted in a foam bed or with plaster. I really don't think it matters that much how it is casted or what the material is as long as the three-dimensional contour of the superior surface of the orthosis is made correctly and the orthosis stiffness is correct for the patient.
Doug Richie did nice reviews of posterior tibial dysfunction for Podiatry Today seven years ago and four years ago which should be a nice starting point for you.
Hope this helps.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: Post-op orthoses following tib post repair with FDL transfer and calcaneal osteotomy
Hi Kevin and Graeme,
Thank you for your replies. Have just come back from Chrsitmas break, so haven't had a chance to go through the literature you pointed me to yet Kevin, but I will and I will also contact Doug Richie if necessary!
So uplifting to come back to this minefield after a holiday!
Post-op orthoses following tib post repair with FDL transfer and calcaneal osteotomy
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