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With the warmer weather finally arriving, now is a great time to think about your retail ranges for Spring/Summer.

Here at DLT, we offer an extensive choice of retail products which have been developed specifically for Podiatrists to sell on to their patients. They are designed to complement your podiatry treatments, to allow you to provide an extra service and generate additional revenue for your practice. 

With a new range of products in stock for 2022, now is a great time to refresh your retail offering. 

Foot Creams

There is a huge choice of foot creams currently on the market and we are pleased to offer leading brands including CCS, Flexitol, Gehwol and Ureka Footcare. 

New to the DLT range for 2022, Footmender All in One is a patented class IIa medical device specially developed to treat and heal dry feet, hard skin (calluses), corns and cracked heels (heel fissures) with a single product.  It delivers a triple action effect to exfoliate, restore and protect.  It allows patients to use one product rather than separate products to exfoliate and moisturise the skin.  Patients only need to apply once a day as a treatment or once/twice a week for maintenance.

Dr.’s Remedy

We expect Dr.’s Remedy to be an extremely popular retail item for Spring/Summer 2022. With many patients going on holiday for the first time in years, weddings to attend and social occasions aplenty, many will be looking for the perfect nail colour and nail care accessories to deliver healthy, beautiful nails.

Our new colours for 2022 are a must for your retail display, we love the new pastel tones of Perceptive Periwinkle and Lyrical Lilac.

If you are considering stocking Dr.’s Remedy for the first time or need a full re-stock, take a look at the Dr.’s Remedy Starter Kit which features 25 of our best-selling colours, together with accessories including the Remedy Hydration Treatment, Restore Ridge Repair, Base-Coats and Top-Coats. 

*image for illustration purposes*
*colours may vary due to stock availability*

Body Essentials

The beautifully presented range of Body Essentials natural footcare products offers an excellent retail option for your practice, the uniquely blended therapeutic aromatherapy oils are designed to help relieve common skin and nail conditions.  In the summer months, Ditch that Itch – a calming oil for itchy feet and Nourish that Nail ,which helps to restore the condition of nails and protect against damaging germs and bacteria, are best sellers from the range. All Body Essentials products are 100% natural and vegan friendly. 

Clinisept Retail Display

We are excited to offer the new Clinisept Retail Display for 2022, ideal for promoting the versatile Clinisept+ Anti-Microbial Footcare product to your patients. Clinisept+ enables your patients to maintain optimum levels of foot hygiene at home, either following a procedure to aid recovery, or as part of their daily hygiene routine.     

Thought Socks

Our latest collection of Thought socks has just arrived, offering a wide choice of single pairs for women and men– alongside gift packs providing something for all ages and interests. We also offer the Thought Diabetic Socks – these relaxed top socks are ideal for patients with sensitive feet or those suffering from diabetes.

Podopro Gel Range

Our Podopro Gel range has been expanded for 2022 and is now provided in retail-ready euro hook packaging. Shop from best sellers including the All Gel Digital Toe Cap, Gel Toe Crest and Digital Tubes. View our latest additions to the range including the Bunion Guard, Universal Toe Cushion, and Gel Moisturising Heel Sleeve.      

We are here to help if you would like assistance in choosing retail products, contact your DLT Business Development Manager or sales@dltpodiatry.co.uk and we would be happy to put together a retail package tailored to your practice.

Choosing instruments for your practice is largely a personal decision. However, the vast array of nippers, files and probes can often be daunting, especially for newly qualified practitioners. There are a few key considerations which will help you select the most suitable instruments to meet your individual needs.  

Which nail nippers should I choose?

The first thing to consider is for what purpose will you be using the nipper?  Fine pointed nippers are designed for ingrown nail trimming and general-purpose nippers for nail cutting.

Fine Pointed Nipper

Podopro 13cm Angled Ingrown Nipper
Available for £20.95 (ex VAT)
Code: SW632

General Purpose Nipper

Podopro 14cm Straight General-Purpose Nipper
Available for £23.95 (ex VAT)

Code: SW79415

Fine Pointed Nippers are sometimes used incorrectly for general purpose work as some practitioners find them easier and lighter to handle. Using a fine pointed nipper for general purpose work will reduce the longevity of the nipper and cause it to quickly become blunt. If you are more comfortable handling smaller or lighter nippers, we recommend you consider the PodoPro Petite Nipper Range. At only 12cm and up to 40% lighter than equivalent full size general purpose, Petite Nippers offer the strength and pattern of a standard general purpose nipper but in a smaller size which is easier to grip if you have smaller hands.

Petite Nippers

Podopro Petite Concave General-Purpose Nipper 12cm
Available for £23.95 (ex VAT)
Code: PET794

When selecting ingrown nippers, think about how many different sizes you will require, ingrown nippers are available in 4 different lengths with a variety of patterns from very fine for delicate work up to regular size ingrown nippers. Most practitioners will have at least 2 different sized ingrown nippers within their instrumentation.    

General Purpose Nippers are also available in a choice of options but there is not really a need to hold different styles as they will all fulfil the same purpose. There is the option of a straight or concave head plus smooth or patterned handles, but your selection here can be made purely on personal preference. Cantilever General Purpose Nippers are also available, these are designed for use with gryphotic or dystrophic nails and will cut through these larger, thickened nails more easily than standard general-purpose nippers, putting less sprain on the practitioner’s hand and wrist. 

Are Solingen nippers worth the extra investment?

If you are used to working with Solingen nippers and take good care of your instruments, then they are undoubtedly worth the additional investment.  Solingen nippers are manufactured to a very high level of workmanship, offering a more refined instrument that you should find smoother and more comfortable to use. To preserve the more pleasant user experience of Solingen nippers it will be essential to ensure your instruments are well cared for and maintained. 

Whichever nippers you choose whether they be our Cutlass Solingen or our competitively priced PodoPro range proper maintenance and cleaning is vital to ensure the longevity of the nipper. A set of instruments will often go through in excess of 1,000 sterilisation cycles per year and they are therefore some of the most heavily used items within your practice equipment. As part of your decontamination process, the following should be carried out:

  1. Pre-soak to remove tissue residues
  2. Clean in an ultrasonic cleaner or manually scrub
  3. Lubricate prior to sterilisation to protect joints and hinges using specialist medical grade lubricant
  4. Steam sterilise in an autoclave
  5. Remove from the autoclave as soon as the cycle ends (leaving instruments in a damp autoclave will cause staining on the instruments)

What other instruments will I require alongside nippers?

This will depend on the treatment being offered.  Most practitioners will have instrument sets comprising of a nipper, blacks file, blade handle and diamond deb foot file.  For more complex procedures such as nail surgery a wider range of instruments will be required.  Many practitioners opt to use reusable instruments for general treatments and use Sterile Single Use Procedure Packs for Nail Surgery.  Alongside our extensive range of reusable instruments, DLT also stock Susol Single Use Nail Surgery PNA Sets.

Susol single-use Nail Surgery (PNA) Set
Available for just £9.50 (ex VAT)
Code: SUSDP03

How many instruments will I need?

After determining which instruments you feel most comfortable working with its time decide how many sets you think you will need. This will largely depend on how many patients you intend to treat per day, how often you plan to run your autoclave and where you intend to work. As a guide we recommend purchasing 10 to 12 sets of instruments per practitioner when starting out, as this should normally provide sufficient instruments for a day in practice. As your practice becomes busier it is likely you will need to run at least one sterilisation cycle within the working day or alternatively purchase additional sets of instruments.

Here is an example starter package based on the most popular instruments we sell.

ItemQuantity
General Purpose Nipper either Straight or Concave12
Fine Pointed Nipper Regular 13cm4
Fine Pointed Nipper Delicate2
Blacks File Standard6
Blacks File Fine6
Dressing Scissors2
Swann Morton No 3 Blade Handles12
Diamond Deb Foot Dressers12
Diamond Burr12

If you treat a large number of patients off site in one session such as in a nursing home, you may find Sterile Single Use Procedure Packs more convenient.  It is also handy to have a few of these sets in clinic in case of autoclave breakdowns or last minute patient bookings.  DLT stocks the Susol Single Use Nail Care Sets. 

Susol single-use Nail Care Set
Available for just £3.90 (ex VAT)
Code: SUSOLNCS

DLT offers a large selection of instruments including our competitively priced Podopro range and premium quality Cutlass Solingen range. If you require further help and advice in selecting podiatry instruments or would like a quotation for starter sets, please contact Sales on 01484 641010 or email sales@dltpodiatry.co.uk.

SHOP ONLINE AT www.dltpodiatry.co.uk

During an average working day most podiatrists will lift their patients legs manually into position during a procedure. The average leg is around 10% of a person’s body weight, a 10 stone/64kg patient will have legs weighing around 6.4kg each. The position in which the practitioner is required to place themselves in to manually lift their patients’ leg requires them to get very close to ground and then lift at a 90-degree angle. This makes it much more difficult to follow optimum manual handling practices.

It is important to consider the repeated strain this may place on the practitioners neck and back. 

The Lemi Podo 5 Patient Chair is the only dedicated Podiatry chair with a dual electric leg rest function. The chair is ideal for lifting heavy oedemas limbs without straining the practitioner’s neck and back. It also benefits from independent electric adjustment of seat height, tilt and back rest inclination. The maximum working height of 128 cm and a 180° rotation allows optimum positioning for comfort and access for both the clinician and patient. The Lemi Podo 5 Patient Chair allows you to effortlessly place your patient in the perfect position with all chair movements being operated by the foot control. The single touch home function returns all the features back to their original position easily and quickly at the end of the treatment.

In addition to offering hands free electrical operation, the Lemi Podo 5 Patient Chair also provides a number of features to ensure a comfortable treatment experience for the patient.  The high quality contoured upholstery provides the ideal balance of cushioning and support.  The height adjustable head support and extendable leg supports will accommodate both smaller and taller patients in equally high levels of comfort.  With a maximum weight limit of 250kg (39 stone) and a generous seat, the Lemi Podo 5 will easily support larger patients whilst the overall footprint of the chair remains compact allowing it to fit even the smallest of surgeries.

As well as ensuring the patient is placed in the optimum position for treatment it is also advisable to consider the location and design of other elements of your treatment workstation. Gerlach Surgery Cabinets are DLT’s most popular surgery units, they provide the perfect combination of ergonomics and aesthetics in a high-quality construction. With the option to mount a bracket on either side of the cabinet, the design is equally suitable for right or left handed practitioners. The braked castors allow for easy positioning of the unit and the drill drawer will pull forward from the unit to allow easy access during treatment.

The Gerlach unit has a generous drill space which will accommodate most drills, we suggest our highly regarded PodoTronic Opus Podiatry Drills. These competitively priced drills offer quiet, high performance dust extraction. The hand-piece on/off switch results in less twisting and turning to access the drill control panel during treatment.

Poor working ergonomics has the potential to place more stress and strain on the body which can result in practitioners working in pain, taking days off work and possibly shortening their working life. With many years’ experience in helping practitioners to select the most appropriate equipment to suit their individual needs, DLT are here to help you find the perfect solutions for your practice.  Our friendly and knowledgeable team will personally deliver and install heavier weight equipment such as Patient Chairs and Cabinets, providing any training required.    

For further information about podiatry equipment from DLT please contact sales on 01484 641010.

Cambridge Masks filter air through three different layers . . .

Cambridge Mask Face Mask

1. The Primary Filter Layer

The first layer of the Cambridge Mask filters out larger particles such as dust and PM10. The material is sublimation printed in different patterns to make the masks fashion friendly.

Cambridge Masks

2. The Three-Ply Micro Particulate Layer

The second layer of the mask blocks particulates such as PM2.5. It also filters 99.79%+ of particles as small as PM0.3. The textile is a three-ply non-woven melt-blow polypropylene, a thermoplastic polymer used in a range of applications.

The blow moulding process begins with melting down the polymer and forming it into a “parison” – a ball of liquid. High velocity air is then passed through to attenuate the filaments and create a fibrous web. The random fibre orientation this triggers is advantageous because it creates a better mesh to trap particles. The textile is also created with a high surface area, meaning a greater percentage of particulates are captured as they pass through the filter.

Cambridge Mask

3. Military Grade Carbon Filter

The Cambridge Mask Pro is completed with the inner filter which is made from a 100% pure activated carbon cloth, which was originally invented by the UK Ministry of Defence. It was then extensively developed and made into a product for use in chemical, biological and nuclear warfare protection, of the type used by armed forces around the world. We hold the exclusive global rights for this material for use in a consumer pollution mask. You won’t find it in any other mask outside of the military.

All activated carbons – traditionally powders and granules – generate “Van der Waal” forces due to their porous structure. These forces give activated carbons their unique potential to adsorb gaseous molecules, including anions and cations into their internal pores.

Cambridge Mask

Our filter material is comprised of a series of activated carbon filaments, each about 2,000 nanometres in diameter. Each filament is many times smaller than the typical grain size in standard carbon materials, making the rate of adsorption of pollutant gas much faster and therefore more powerful. It also means that bacteria and viruses are drawn to the filament surface much more efficiently, because there is so much more available surface than in a granular carbon.

The high number of filaments – spun into a yarn and then woven into cloth – makes the speed of adsorption extremely fast in a material that is still easy to breathe through. Not only are molecules such as pollutant gases and endotoxins quickly adsorbed into the pores from a much wider area, but the Van der Waals forces also attract and immobilise on the filament surface much larger particles including bacteria, which often have a negatively charged membrane. Together with the anti-bacterial silver added to the filament surface, the activated carbon cloth traps the bacteria and draws out the gel-like cytoplasm inside – killing it and preventing infection.

Cambridge Masks are therefore powerful respirators that not only clear the air of pollution via the particulate filter, but also remove potentially harmful gases and pathogens with the additional carbon filter.

Cambridge Face Mask

VIEW CAMBRIDGE MASKS

Cambridge Mask face Mask

Cambridge Mask Face Mask

What products do you have?

We currently have the PRO Cambridge Mask, which is available in 5 sizes to fit children and adults. We also provide a head-strap and nose foam to help the masks fit better.
The PRO Cambridge Mask is made by combining 3 unique layers; the outer printed layer, the three-ply particulate filter, and an activated carbon cloth which is tested British Military Filtration Technology and filters almost 100% of pollution, gases, 99.6% of viruses and 99.7% of bacteria. The PRO mask is also treated with silver to protect the wearer against bacteria and viruses. PRO masks have a  lifespan of up to 340 hours of use.

Cambridge Mask Face Mask

 

How long can the mask be used for?

Cambridge Masks are non-disposable and can be used up to 340 hours. The length of time is affected by the level of pollution/dust. A table is provided below:

Cambridge Mask Face Mask

Please note that the mask can be hand washed with soap and hot water. However, this will not extend the life of the filters as the pollution will be locked into them. The mask will need replacing after extended use to ensure proper filtration

What does the valve do?

The valve works by opening when you exhale and closing when you inhale. The easiest way to see this in operation would be to look in the mirror and observe it opening and closing as you breathe.

We have made improvements to the valve to adjust the thickness of the inner membrane. This makes it easier for the valve to open and close at the exact time you are exhaling and inhaling.

 

Filter Technology – What does the Mask Filter?

Almost 100% of Particulate Matter (PM) including PM10, PM2.5 and PM0.3. These are the sort of particles you find in coal dust from power stations, diesel exhaust fumes, factory emissions, and from construction works.

• Almost 100% of gas based air pollution, including odours such as Volatile Organic Compounds (VOCs), Ozone, Benzathine, and Formaldehyde. These particulates you can find in petrol fumes, chemical emissions, and from many industrial processes.

• Almost 100% of harmful pathogens such as viruses and bacteria. 

• Other airborne irritants or allergens such as dust, mould spores, some odours, pet allergens and pollen.

 

Who is the Mask for?

• Anyone exposed to Viruses. Viruses usually travel on droplets of water, which are very large. The mask will block these particles. The Cambridge Mask PRO filters are treated with silver, which works to enhance the anti-viral properties of the technology.

• Anyone seeking protection for airborne irritants such as dust and mould

• People in at risk groups for respiratory disease, including children, elderly, pregnant women and those with existing respiratory conditions.

 Asthmatics and allergy sufferers including Hay Fever. 

 Hobbyists and DIY such as woodworking and sanding.

• Anyone exposed to urban environments with high air pollution levels – any big city often has higher air pollution.

 

Couldn’t find your question here?

Please ask in our blog for more information. Thanks

There is a high level of confusion about which sanitising products are effective against the Coronavirus. Using any sanitiser is a good thing, but many are no more effective than a thorough hand wash with hot water and soap.

For example antibacterial sanitisers are only effective against bacteria, not viruses. Antimicrobial sanitisers however act against a range of micro-organisms including bacteria, fungi and viruses.

Alcohol is one of the lesser effective chemistries and has to be used in concentrations of at least 70% in order to be effective. Many alcohol sanitisers contain far lower concentrations than this.

The antimicrobial effectiveness of Clinisept+ has been vigorously and independently tested, proving it to exceed the recognised levels of performance required of this type of product.

Clinisept kills coronavirus

Clinisept+ Aftercare 100ml Trade £5.15 + VAT

Clinisept kills coronavirus

Clinisept+ 250ml Trade: £5.50 + VAT

Clinisept+ kils coronavirus

Clinisept+ 500ml Trade £6.50 + VAT

 

 

Clinisept+ can be sprayed liberally directly onto the hands, face and surfaces to provide rapid protection against contamination.

Clinisept+ contains a proprietary ultra-pure hypochlorous solution which enables it to provide effective cleansing at a fraction of the strength of traditional cleansing chemistries.

Clinisept+’s hypochlorous has a unique oxidising method of action which cleanses and provides antimicrobial protection but is also completely skin safe. It doesn’t harm, irritate or sensitise the dermal layer. And because of the product’s oxidising method of action, organisms cannot become immune to it, meaning it is not subject to anti microbial resistance.

The chemistry has undergone extensive independent testing proving not only its extreme effectiveness, but also the fact that it has a skin neutral pH, is hypoallergenic and is even non-cytotoxic. (Not toxic to cells.)

Clinisept+ truly is the holy grail of skin cleansing. The reason Covid-19 is so serious is that the virus is both resilient (there is no vaccine) and also virulent, which is why it has spread so quickly around the world.

The speed with which a virus spreads is measured by its ‘reproductive number’, or R, which in layman’s terms, is the number of people that one individual with the virus will infect. If the number is greater than one, then the infection is spreading. If it is less than one, then it is in decline.

Recent estimates have put the R index at 2.5, however it has reached well over 3 in China and Italy. This means that every person that has Covid-19 transmits it to two or three others.

Covid-19 is therefore growing exponentially and is not going away anytime soon.

To beat coronavirus, we have to get the R number down, to below 1.0. So how can we achieve this? There are four key aspects that influence the R: the duration that someone who has the virus is infectious for, the number of people an infected person comes into contact with whilst they are contagious,

whether the contact is sufficient for transfer of the virus to take place, and the susceptibility of the people who become exposed to it.

Because we don’t have any medicines or vaccines that are effective against Covid-19, we can’t do anything about the length of time someone is infectious and neither can we change how susceptible we each are to the virus, and as we know the elderly or those with respiratory conditions are far more susceptible.

However, we clearly can influence how much contact we have with other people and therefore how much we expose ourselves to the danger of becoming infected.

Put simply, if you don’t come into close contact with someone who has the virus and you don’t touch a surface that has been contaminated with it, you will not become infected.

Completely avoiding contact with other people and the surfaces they have touched is almost impossible, so frequent hand washing and sanitising with an effective chemistry is essential. Evidence of Clinisept+’s effectiveness has been presented to HSE and the Government and a submission has been made for fast-track approval as a skin disinfectant for use during the current pandemic.

 

 

 

ICB Lower limb biomechanics

Achilles pain can apply to a number of conditions that impact upon the Achilles tendon area. Generally most surgeons refer to any condition that elicits pain in the area of the Achilles attachment as Achilles tendonitis. Specifically, the makeup of the word is, ‘tendon’ meaning tendon and – ‘itis’ – a suffix used in pathological terms that denote inflammation with its origin being from the Latin language.

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Different professions have sort to be more specific in the description of the condition and thereby more closely define this area of pain to design better treatment regimes. Terms such as Achilles tendinopathy, tenopathy, tendinosis, partial rupture, paratenonitis, tenosynovitis, tendovaginitis, peritendinitis, and achillodynia have been used to describe the problems of non-insertional pain associated with this tendon1.

In this blog we will be considering the overuse and inflammatory condition that is associated with Achilles pain, with pronation and supination as main contributory elements.

The biomechanics of the condition starts at heel strike in the gait cycle. After heel strike the foot accelerates into an excessively pronated position and the calcaneus is everted, increased medial tendoachilles traction occurs and may result in transverse shearing of the tendon and sheath, eliciting inflammation and pain.

Achillies Tendonitis

Additional stress is encountered at heel lift as inversion of the calcaneus is assisted by the gastrocnemius and soleus muscles.

Achilles (pain) Tendonitis is similar in its biomechanical action to Plantar Fasciitis in that as the foot pronates, it causes a tractional pull on the attachment and continued Subtalar Joint pronation for any length of time, will allow continuation of the tearing of the sheath. Inflammation and swelling will occur as this continues to takes place.

This action of continual stretching and bending is likened to constant bending of a piece of wire in which the wire heats up in the area of flexion and eventually dips/bends and snaps. The heat generated in the wire is similar to the inflammation that occurs in the Achilles in which inflammation is evidenced when constant stretching and strain occurs. If the patient excessively pronates constantly, the inflammation will be more prominent on the medial side and conversely, supination on the lateral side as the patient strikes with a high strike angle laterally and then proceeds to pronate through midstance, then to toe-off. Inflammation can occur on both sides due to this being the biomechanical pivot point.

The engineering graph below gives an insight into stress studies that have been conducted on building material, however, this principle has been adopted by bio mechanists as they apply it to ‘body engineering’.

Achilles Tendonitis graph.

Looking at the graph we have stress and strain vs time or physiological range. A to B is any material that returns to its shape over a period of time – in this case the stress and strain on the Achilles tendon is associated with abnormal foot function.

B-C is the yield point – the point at which the Achilles tendon is stretched so much that it is unable to return to its original shape. When this transpires inflammation occurs and pain is felt. At this point the patient seeks medical help, and often the symptom is treated, however the biomechanical cause may go untreated. With rest the pain may subside, repetitive stretching of the Achilles tendon will move the condition towards point D, i.e. continual flare up of the Achilles tendon may take place.

Point D is where complete rupture of the tendon may occur or a posterior calcaneal compensatory spur may develop as the body seeks to maintain the attachment.

Changes to the patients’ lifestyle e.g. job change or a new exercise routine may cause additional stress being placed on the biomechanical structure, causing aches and pains to occur in the ankle, knees, hips or even lower back pain. The additional stress on the body will most likely present as pain in an existing area of weakness, and be associated with biomechanical anomalies causing periods of pain and discomfort to occur.

Treatment

The position or point of pain can be a clear indicator of underlying factors. When pain is on the medial side of the Achilles, it is often associated with Subtalar Joint pronation – as it causes the medial aspect of the Achilles tendon attachment to elongate and tear, and will need to be treated with an anti-pronation orthotic.

When the pain is on the lateral side it may be associated with a high forefoot valgus or a high supination angle that causes the lateral attachment to elongate and possibly tear and should be treated with a forefoot valgus addition. If the rearfoot (calcaneus) is flexible a lateral posting can be applied.

Pain in the centre or both sides of the Calcaneal attachment often this is associated with supination at heel strike with ground reaction forces on the lateral side encouraging the foot to move into a pronated position at midstance to toe-off phase of gait. The lateral to medial movement may cause this to be the pivot point of traction of the Achilles tendon and will inflame or flare up the medial and lateral side of the tendon sheath and bursa. Treatment will require both treating both excessive pronation and excessive supination by using orthotic additions attached to the orthotic device to support the arch and address any forefoot valgus deformity.

forefoot valgus addition on ICB sports orthotic

When prescribing orthotics always check for any structural leg length discrepancy, especially if unilateral Achilles pain is being experienced as the longer leg can, as compensation, excessively pronate to level the pelvis.

Repetitive stress and strain on the Achilles over a period of time may cause a posterior calcaneal spur to develop as compensation. Surgical intervention to remove a Posterior Calcaneal Spur can be accomplished without detachment of the Achilles tendon. Successful surgical intervention on a posterior calcaleal spur is more successful than surgery on an Inferior Calcaneal Spur (heel spur).

Additional Treatment Option

• Foot Mobilisations: especially to check if the calcaneus is displaced posteriorly, as this will exert additional traction pressure on the Achilles.

Short term use of a heel lift on both feet (in addition to an orthotic device) to shorten the gastrocnemius muscle and relieve pressure on the Achilles attachment. Do not allow the patient to continue wearing the heel lift for more than 2-3 to reduce Gastrocnemius shortening inflammation should subside in this period of time..

 

ICB orthotic heel lift

• Acupuncture (or dry needling): at the point of pain can be attempted to reduce to the swelling and inflammation.

• Non steroidal Anti-inflammatory Medication: only in the early stages of the condition.

• Cortisone: is initially effective, however it weakens the ligament structure and it is advised to limit use to one or two occasions. A more conservative approach will be far more beneficial to the patient.

Corticosteroid injections into the region of pain is a common treatment for plantar fasciitis and often Achilles pain. However, such injections have been associated with serious side effects2. Acevedo and Beskin3 reported that in a group of 765 patients with a clinical diagnosis of Plantar Fasciitis, 51 were diagnosed as having a plantar fascia rupture. Of these 51 ruptures, 44 (86%) were associated with corticosteroid injection4. Therefore reliance upon this form of treatment is discouraged for Achilles pain also and a more conservative approach adopted.

Get a FREE Achilles Tendonitis Poster

Free poster-Achillies-Tendonitis

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References

1 Khan KM, Maffulli N. Tendinopathy: An Achilles’ Heel for Athletes and Clinicians. Clin J Sport Med.1998 Jul;8(3):151-42.
2. LEMONT Harvey, DPM. Plantar Fasciitis A Degenerative Process (Fasciosis) Without Inflammation
3.AMMIRATI Krista M. BS, USEN Nsima, MPH May/June 2003, Vol 93, No 3 Journal of the American Podiatric Medical Association
4. ACEVEDO JI, BESKIN JL. Complications of Plantar Fascia Rupture Associated with Corticosteroid Injection. Foot Ankle Int. 1998 Feb;19(2):91-7.

General REFERENCES: BRUNKER, P., & KHAN, K. (1993) Clinical Sports Medicine, Sydney: McGraw-Hill Book Company

ICB Lower limb biomechanics

The question is of course: What is regarded as success?

When dealing with Orthotic therapy we are not attempting to heal and often we are not attempting to eradicate the biomechanical issue. Rather we are working within the parameters of a mechanical device to provide the patient with short, mid and long term relief to the pain and discomfort that they are suffering. We also may offer a method to stop an issue progressing to the next level.

Orthotic therapy is NOT a ‘cure all’ for every disease, however, when used in combination with other treatment modalities, can provide improved gait, reduce pain, assist in providing an enhanced quality of life to patients.

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There is a wealth of information attesting to the benefits of orthotic therapy for a wide range of biomechanical conditions, such as:
• Hallux Abducto Valgus (bunions): commonly caused by a short 1st metatarsal shaft and aggravated by excessive pronation.
Ball of foot pain

• Ball of Foot Pain: collapsing and rotating of the metatarsals caused by pronation.

• Plantar Fasciitis & Heel Spur: excess pronation causes the fascia to elongate and tear at the attachment to the calcaneus. An inferior calcaneal spur is a secondary compensation, in which an osseous growth develops at the attachment to secure the fascia.

• Achilles Pain: repetitive over-stretching of the medial and lateral attachments of the Achilles tendon caused by both pronation and or supination, create a point of pain or stress point.
Podiatry and foot anatomy

• Severs Disease (children’s heel pain): related to pronation and growth spurts in children and affects active sporting children more than sedentary ones

• Shin Splints (lateral, medial or an-terior): pronation and supination can be key contributing factors.

• Knee Pain: and collateral ligament strain due to pronatory and supinatory factors and or forefoot anomalies.

• Osgood Schlatters Syndrome (children’s knee pain): occurs due to a combination of tibial torsion, growth spurts and pronation factors.

Knee Pain

Hip Pain: due to structural or functional leg length difference and supination/pronation factors including tight external hip rotators and structural long leg compression into the acetabulum.

Low Back Pain: unilateral and bi-lateral pronation and structural and functional leg length difference causing stress on the lower back L1-L5.

Leg Length Syndrome: when a structural leg length difference is evident the long leg may excessively pronate to level the pelvis.

 

A report by The American College of Foot & Ankle Orthopaedics & Medicine titled ‘Prescription Custom Foot Orthoses – Practice Guidelines’,1

Gives a wider and more comprehensive array of conditions when in their opinion are able to benefit from the application of prescription orthotic products. The ICB heat mouldable range of orthotics are a simple, cost effective efficient way to treat your patients with customised prescription orthotics and do it right in your own private clinic.

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The quoted report lists

1. Proximal Lower Extremity Pathology: A. Shin Splints, B. Tendonitis (Tenosynovitis), C. Posterior Tibial Dysfunction, D. Chondromalacia Patella (Runner’s Knee, Patellofemoral Syndrome), E. Iliotibial Band Syndrome, F. Limb Length Discrepancy

2. Arthritides: A. Inflammatory Arthritis, B. Rheuma-toid Arthritis, Psoriatic, C. Arthritis, Other Inflammatory Arthritides, D. Osteoarthritis.

3. Mechanically Induced Pain and Deformities: A. Pes Cavus, Haglund’s Deformity , B. Hammer Digit Syndrome, C. Functional Hallux Limitus, Hallux Limitus and Hallux Rigidus, D. Plantar Fasciitis, E. Equinus, F. Sinus Tarsi Syndrome, G. Tailor’s Bunion (Bunionette), H. Hallux Abducto-Valgus (Hallux Valgus, Bunion), I. Pes Planus, J. Metatarsalgia, K. Sesamoiditis, L. Morton’s Neuroma (Intermetatarsal Neuroma).

4. Paediatric Conditions: A. Calcaneal Apophysitis, B. Genu Varum and Genu Valgum, C. Tarsal Coalition, D. Metatarsus Adductus.

The issue of success is really not in question, rather when where and how to use orthotics to benefit the patient is!

There are then 3 main questions regarding orthotic therapy to ask when treating patients and these are :

1. Does the patient present with a condition that has been reported to be successfully treated with orthotics?

2. Does the patient present with asymptomatic lower limb biomechanical anomalies or faulty foot mechanics? The patient can also be presented with orthotics as a preventative or prophylactic treatment.

3. Will the support and stabilisation offered by orthotic therapy enhance the overall treatment outcome? This is a personal, clinical determination to be made by the practitioner.

A consideration is:
The cost of prefabricated heat mouldable foot orthoses is relatively low, and the adverse effects of using foot orthoses are minor. (see below 2,3).

There are 3 key starter steps in orthotic therapy:

Check for pronation and supination

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References:

1. The American College of Foot & Ankle Orthopedics & Medicine. Prescription Custom Foot Orthoses – Practice Guidelines, December, 2006

2. COLLINS N, BISSET L, MCPOIL T, VICENZINO B. Foot Orthoses in Lower Limb Overuse Conditions: A Systematic Review and Meta-analysis. Foot Ankle Int. 2007;28(3):396-412.

3. RICHTER, Randy R. PhD, PT; AUSTIN, Tricia M. , PhD, PT, ATC; REINKING Mark F. , PhD, PT, ATC, SCS. Foot Orthoses in Lower Limb Overuse Conditions: A Systematic Review and MetaAnaiysis— Critical Appraisal and Commentary

Heel Pain Management

Heel pain can be unpredictable and occasionally problematic to resolve. So we teamed up with Healthy Step to produce a heel pain pathway to pain free heels.

The HeelFixKit is the most innovative and cost effective approach available in the management and treatment of heel pain, plantar fasciitis and heel spurs. The HeelFixKit contains specially designed Insoles, Therapy Balls, Heel Tape & Heel Cups. Developed by a British Musculoskeletal Podiatrist, Andy Horwood, the pack is designed to allow you to treat your heel yourself and make dramatic improvements in just six weeks.

HeelFixKit for heel pain

By combining insoles, taping, stretching and strengthening the foot, a treatment programme is initiated that treats the heel pain holistically. The treatment regime not only helps settle the pain but also prevent the re-occurrence of heel pain, and its all achieved at home. the kit is £14.95 ex vat for trade and RRP: £34.95.

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How to make the most of your HeelFixKit

The heel fix kit comes with an exercise information sheet, as the exercises are essential to improving the pain and returning to activity.

Heel Pain Pathway – Help your patient with their pain with: 

• Downloadable heel pain pathway flow chart
• Exercise Videos to share on social media
• Downloadable heel pain sheet

Below is a printable self-help flow chart for your patients to help support their heel pain.
Print the large version here: A2-Heel-Pain-Pathway

Heel Pain Pathway Download

See the videos below for exercises that you can share and send to your patients.

Foot Therapy Ball –
Simple exercises to help strengthen your feet:

Stair calf exercise for non-insertional achilles tendinopathy.

An easy 3 step exercise to help strengthen your feet

Your patient can use this handy Pain Sheet to reassess their pain level every two weeks while following the advice on this pathway below. Print the large version here 32-Week-Pain-scale-1

Heel Pain Sheet

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ICB Lower limb biomechanics

Arch pain when wearing orthotics can be problematic as it often encourages patients to ‘give up’ on orthotic therapy.

The Plantar Fascia is a fibrous tissue that does not exhibit the capacity to stretch or elongate and so often the fascia presses onto the arch of the orthotic causing discomfort.

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The fascia assists in maintaining the longitudinal arch shape, however, can be an issue when it presents as a short fascia or excessively protruding fascia.

Image show Plantar fascial drop occurring at the 1st MTPJ performs the windlass mechanism during toe off phase of gait.

Inflammation and tearing at the heel bone

A tight fascia can also contribute to plantar fasciitis and heel spur syndrome due to the tension on the attachment at the calcaneus.

A Plantar fascial groove can be used when the plantar fascia is very tight or the patient indicates that the arch of the orthotic is causing pressure in the arch area.

Fascia Position

Generally the plantar fascia position on the orthotic device is located approximately 1 cm lateral to the medial boarder of the orthotic device.

The ICB orthotic can be easily modified using a heat gun to heat the area to be deflected.

ICB Heat Gun

The groove can be made using metal scissors or another similar item.

ICB Orthotic

When making the groove ensure that the heat is applied only to the plantar fascia position on the orthotic device to reduce any unwanted distortion of the EVA material.

For a more permanent solution the groove can be placed into the orthotic device using either a bench grinder or Dremel hand grinder.

ICB Orthotic For Heel Pain

The groove is created 1 cm from the medial aspect and runs the length of the arch of the orthotic device.

If the patient is suffering significant pain we advise the following step by step procedure to pain relief.

The first step would be to place a plantar fascial groove as this will allow the fascia a plantar drop and take pressure off the fascia.

Grind Orthotic

If pain persists due to the arch collapsing on the arch of the orthotic use a bilateral Rearfoot Inversion addition which will reduce elongation of the fascia by inverting the rearfoot .

ICB Orthotic Rearfoot Varus

If further adjustment is required a 1st Ray cut away or 1st MPTJ deflection will be required to reduce tension on the fascia.

Both 2/3 and Full Length deflections work effectively in reducing the tension on the fascia.

ICB orthotic

Orthotic therapy is one in which some minor adjustment may be needed when treating patients.

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