Donald Shurr, CPO, PT, presented two segments of the Diabetic Foot instructional course at the American Academy of Orthopedic Surgery (AAOS) annual meeting in Anaheim, Calif., February 4, 1999. Shurr presented "The Care of the Diabetic Foot: An Orthotist's View" and an update for the prosthetic care of the diabetic amputee.

Dr. Charles Saltzman, head of Foot and Ankle Services at the University of Iowa Hospitals and Clinics, served as chairman for the course. Other panel members included Dr. Greg Guyton, a graduate of UI's orthopedics program who is currently with Dr. Roger Mann in San Francisco while finishing his foot and ankle fellowship. Registration for the four-hour course numbered over 200.

Review of Related Presentations
Johnson, et al, reported on the use of the custom-molded polypropylene AFO, leather-lined, when used for Johnson Type I and II posterior tibia tendon dysfunction (PTTD). All patients were evaluated pre- and post-fitting using three scoring systems. The mean follow-up was 12 months and average age was 57.3. Seventeen of 21 patients were using the orthosis at time of follow-up. This prospective study revealed improvement via scoring systems in 17 to 21 (90 percent) of the patients.

Kirkley from London, Ontario, reported on a prospective, parallel study of 119 patients with medial knee joint osteoarthritis (OA) and varus deformity (less than five degrees, greater than five degrees). These patients were randomly placed in three groups, given follow-up questionnaires from two weeks to six months, and asked to perform a six-minute walk and 30-second stair climb. Those fitted in "unloader" type knee orthoses included 41 patients with an average age of 58.2 years. Visual analog scale (VAS) pain scores were significant, indicating that patients with varus knee arthritis benefit significantly from unloader orthoses. On the average, the custom orthosis improves the quality of life.

In another study of knee orthoses, Dennis from Denver, Colo., studied 40 subjects with medial knee OA. Each walked on a treadmill under fluoroscopic surveillance. An "unloader" type knee orthosis was then applied. All patients were overweight, resulting in suboptimal orthosis fixation. Thirty-one of 40 patients demonstrated articular separation of their degenerative knee compartment. The remaining nine, who did not receive adequate orthosis fixation, failed to demonstrate separation. Thirty-one of 40 also demonstrated a change in femorotibial angle (two degrees).

Freedman of Philadelphia presented a study of recent medical school graduates. Basic topics in musculoskeletal medicine were assessed via a 25-question basic competency exam. Content validity was assured by using 154 chairman of orthopaedic training programs in the United States. Results revealed that 82 percent of the medical school graduates failed the examination. This information further confirms the need to establish and maintain close relationship with your general medicine, non-orthopaedic referral courses.

It also speaks to the need for a well-done and -documented evaluation of each patient. Any inconsistencies or confusing findings should be discussed and clarified with the physician prior to implementation of treatment.

Spring 99 index