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One of the keynote addresses was by Richard Baker from the Royal Childre's Hospital in Melbourne, Australia. He clearly pointed out that the magintude of a lot of things we are trying to measure are not greater then the error of measurement of the sYstems we use to measure them!!!!

Hans Savelberg - "Muscle Weaknessand Joint Moment Distribution in Diabetic Polyneuropathy" - showed that muscle weakness occured in leg muscles in those with and without diabetic polyeuropathy, BUT, the effects of the weakness on joint moments was only found in those with neuropathy (nice little finding :-) )

Zoltan Pataky - "Increased plantar pressure as an early sign of peripheral neuropathy in type 2 diabetic patients - found that peak pressure increases and prolonged duation of contact occured before the clinical onset of neuropathy.

Orna Donogue - "Orthoses Control of Frontal and Sagittal Plane Motion During Running in Subjects with chronic achilles tendon injury" - 13 achilles tendon subjects; 15 cotrols - subjects and controls had pronated feet - all given foot orthoses - 93% sucessful in reducing symptoms; 3d gait analysis found significant differences between orthoses and no orthoses in both groups; in barefoot running frontal plane movements were greater in controls than subjects (ie those with achilles tendonitis did not pronate more despite he clinical success of foot orthoses aimed at treating it).



Guldemond - "Clinical Proficiency of Dutch Podiatrists, Pedorthists and Orthotists Regarding Plantar Pressure Reduction" - 3 patients got orthoses from 10 podiatrists, 10 pedorthists and 11 orthotists. There were differences between and within groups in identification of high pressure areas (compared to computerised plantar pressure mesurement) and there were differences between and within professions in the ability of the foot orthoses used to reduce plantar presure - however, their statistical analysis is meaingless as only 3 patients were used.

Activity monitoring is the ot topic in diabetes foot biomechanics at the moment - severl papers were presntd on that, with one concluding that "Our preliminary results suggest that the recognition of a risky activity patten with regard to foot ulceration might be possible..." (Koller et al)

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Dear Sirs

We are writing with reference to ‘Reports from Biomechanics of the Lower Limb, University of Salford, UK’.

Thank you for make reference to our study on ‘clinical proficiency of Dutch podiatrists, pedorthists and orthotists regarding plantar pressure reduction’.

We would like to point out that the foot care specialists were object of evaluation and not the patients. The research question about the variability between - and within three groups of foot care specialists could be answered with only one patient. The number of foot care specialists dictate in this study the statistical robustness of the results. Which was for most issues studied more than sufficient. Therefore we considered the statement ‘the statistical analysis is meaningless’, as an unfortunate misapprehension. Although, the study design and methods were clearly communicated in written and oral presentations.

We appreciate the podiatry arena as valuable and trustworthy platform for discussion on issues regarding foot care. We trust that the editors of podiatry arena will more carefully consider methodological and statistical issues in future, as we do in our commitment to foot care and their specialists.

On behalf of my co-workers,

Yours faithfully

Nick Guldemond, clinical researcher
Dept. Orthopaedic Surgery
University Hospital Maastricht
P.O. Box 5800
6202 AZ Maastricht
The Netherlands
Phone: +31 (0)43 3875031
Fax: +31 (0)43 3874893
Mobille +31 (0)6 42393696


Pieter Leffers, clinical epidemiologist
Geert Walenkamp, orthopaedic surgeon
Nicolaas Schaper, diabetologist
Fred Nieman, statician
Antal Sanders, rehabilitation consultant