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Post by blinda on Sept 28, 2008 21:31:40 GMT
Evening All,
Not sure if this is the right place for this thread....but whilst reading the latest Diabetic Foot Journal yesterday, i came across a short question and answer in the forum section; `When to begin screening children with type 1 diabetes for foot problems`.
The pod advocates inviting a biomech specialist to the paediatric diabets clinic as almost half of those attending "required orthotic intervention".
I was quite amazed at the prevalence. They did not state whether intervention was indicated due to symptomatic pathologies or taken for preventative measure.
Does anyone here prescribe orthoses, with a prophylaxis intention, to juvenile pts with type 1 DM?
Cheers, Bel
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Post by robertisaacs on Sept 29, 2008 17:41:26 GMT
I find this surprising. It depends rather heavily on ones definition of "requiring intervention!" This, in exactly the same way as general paeds is a matter for debate! Personally i cannot see why DM1 paeds should be different biomechanically to other paeds. Not like they're going to ulcerate is it? It may be unkind of me but i wonder if this is one of those times when people have got so fixated on DM people being entitle to stuff they have lost site of the "high risk" bit. Careful, i'm in danger of mounting my soap box in order to mount my high horse! Regards Robert
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Post by blinda on Sept 29, 2008 20:02:40 GMT
This is to what i was alluding to. I am shocked that half of the kids "required orthotic intervention". I wonder how this would compare with a similar size sample group of kids without DM? I too fail to see the connection between DM (in an assumed young and low risk individual) and orthoses intervention. Am i missing somethng?
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Post by Admin on Sept 30, 2008 6:59:49 GMT
It may be unkind of me but i wonder if this is one of those times when people have got so fixated on DM people being entitle to stuff they have lost site of the "high risk" bit. Careful, i'm in danger of mounting my soap box in order to mount my high horse! I'll give you a hand up ;D! Seriously, I agree 100%. We don't have an absolute criteria for normalcy, either in the adult or paed foot (excluding obvious orthopaedic conditions like Pes Cavus or Pes Planus) so how can the paed foot, even in DM1 patients, be screened for normalcy? Doesn't make any sense --- unless a private lab/pod is involved - then it makes some kind of sense .
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podmum
Full Member
"There is no dark side of the moon"
Posts: 169
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Post by podmum on Sept 30, 2008 7:57:06 GMT
Having agreed with all that has been said I do wonder if the prevelance of orthoses in the young DM1 pts is more to do with the litigious society we now live in and if anything did happen to the young feet without orthoses the persons involved would get sued On the other side of the coin if the orthoses were not fitted properly and caused problems they could be in the same boat!!!!!!!! Maybe the question needs to be posed on the Diabetic Forum to see what the thinking is there. Podmum
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Post by blinda on Sept 30, 2008 8:30:19 GMT
Think i might just do that.
Cheers, Bel
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Post by dtt on Sept 30, 2008 11:42:45 GMT
I'll give John McCall a shout an see if he can clarify D
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Post by johnmccall on Sept 30, 2008 12:36:22 GMT
Hi All,
My humble opinion is similar to Robert's because I don't know of any children (yet!) who have diabetic foot complications so I'd treat 'as normal'. If there's a biomechanical anomaly (whatever the criteria for that is..) I'd treat as anyone who doesn't have diabetes.
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Post by blinda on Sept 30, 2008 15:18:44 GMT
Thanks for that John.
Bel
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Post by robertisaacs on Oct 2, 2008 19:22:05 GMT
I hereby declare we all agree. 50% of DM1 children require orthotics smacks of overprescribing! Experts ay?
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Post by Admin on Oct 3, 2008 7:11:52 GMT
I hereby declare we all agree. 50% of DM1 children require orthotics smacks of overprescribing! Experts ay? Absolutely! The only reasons I can think of why a Pod would want to fit this many orthoses are: a) to justify their existence and salary, or b) as I intimated before, a private lab is involved and iffy money is changing hands somewhere down the line.
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Post by dtt on Oct 4, 2008 16:31:27 GMT
Hi All Dave if that maybe the case then it needs looking into We are talking kids here and that Rx ing linked to your suggestion may cause loads of permanent probs in later life unless the practitioners are competent in the Rx. I find it sad that this suggestion has been raised in what is supposed to be a " caring profession" but am streetwise enough to know that it can happen Thanks Johnboy for coming back and checking this site for replies ( see I do keep tabs on you even here ;D ;D) and for your posting Cheers D
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