Evidence Essentials – Blog 2 – December, 2016

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Keep ahead of ‘Dr Google’

Internet browsing prior to professional consultations is now common and increasing rapidly. Whilst some of the information is generic, savvy parents are quick to grasp the concept of ‘best evidence’ versus ‘over-prescription’.

More than ever before, clinicians need to be across best evidence expediently, so that the best available scientific knowledge directs clinical care, as is increasingly sought by parents.

Let me illustrate this by describing a clinical consultation I had this week:

It was a busy consultation room – mother (advanced pregnancy), two little children ages 16 months / 3 years, grandmother, and me. With everyone seated, settled and occupied (blocks, puzzles, books) we began.

The reason for the consultation was concern over the 16 month old child’s “very curved” feet, which “are getting worse since he/Sam started walking 3 months ago”. [NB ‘Sam’ is a fictitious name]

Progressing through the history, and simultaneously observing Sam at play, I described the condition – in this case: isolated, bilateral, congenital, “probably a ‘mild-moderate’ type 2 form of what is called metatarsus adductus”, I said – to which the mother’s reply was: “Yes, that’s what I thought from my googling”.

As I examined Sam to clarify MTA type, severity, flexibility, associations, the discussion naturally turned from diagnosis to treatment – if treatment was indicated – and more specifically, the evidence for any specific treatment.

I showed the mother the 3rd Evidence Essentials monograph (it happened to be at hand!) which covers Metatarsus Adductus. It was so helpful to have this resource so that both the mother and grandmother could see the list of MTA sub-types and applicable treatment options.

When I foot-printed the Sam’s feet, we were then able to jointly see the extent of the MTA, with the mother comparing Sam’s footprints with those from the monograph, and me then clarifying why radiological imaging was not indicated (EE series 1, monograph no. 3, page 11).

I had not actually thought to use Evidence Essentials this way, but as a part of shared decision making with parents about their children’s feet, legs, gait concerns it was really useful.

For interest, here is the Sam’s footprint – ruler approximating an extended heel bisection (Bleck scale) – note curve of lateral border, static atavism of 1st metatarsal (markedly increased with activity).

footprint

It was a great consultation, lovely children, very informed and interested mother and grandmother. Most importantly, we concluded with a shared plan based on best applicable evidence.

 

MTA has been colloquially called ‘2/3 of a clubfoot’ – yet in reality, only the severe or fixed cases are definite concerns.

Both MTA and CTEV (congenital talipes equino varus) can present as mild postural forms from intra-uterine positioning, which spontaneously – or with simple measures eg stretching – correct before 6 months of age.

This situation that is very different from most clubfeet though, as without effective treatment, the deformity never improves, and results in life-long disability, pain, suffering and social stigma for affected children.

In the developing world, where 80% of affected children born with clubfoot deformity live, there is virtually assured poverty without treatment.

 

mockupEvidence Essentials has three objectives:

  1. Evidence Essentials funds ‘Walk for Life’ – the sustainable clubfoot project in Bangladesh – www.walkforlifeclubfoot.org

‘Walk for Life’ recently won the BMJ South Asia Healthcare Award for Excellence in Delivering Primary Care https://www.facebook.com/bmjindia/posts/1568615189820514:0

Everyone who purchases Evidence Essentials simultaneously pays for a child to receive FREE treatment of their clubfoot deformity, enabling them to walk, to go to school and have a hopeful future – thank you, what a gift!

You may like to review our latest results: http://jfootankleres.biomedcentral.com/articles/10.1186/s13047-016-0175-0

  1. APERF (Australasian Podiatric Education and Research Foundation) also benefit from Evidence Essentials
  2. Evidence Essentials brings best evidence to paediatric podiatry practice around the world, advancing your professional development.

 

Please keep an eye out for the Evidence Essentials blogs – every month or so.

Series subscribers will also receive the Evidence Essentials ‘Quarterly’ – a seasonal paediatric foot ‘round up’ emailed directly to you.

 

I hope that you will really enjoy Evidence Essentials. The second series is planned, as is a third! Your suggestions and feedback are very welcome!

 

Kind regards everyone and Merry Christmas!

Angela Evans

 

Dr Angela Evans    PhD, FFPM RCPS(Glasg)

www.angelaevanspodiatrists.com.au