The South African Podiatry Association (SAPA) will be holding their Biennial Congress from 29-31 July 2011, at Khaya Ibhubesi, Parys, in the Free State. The theme of the congress is Developing You – Promoting Podiatry. An interesting mix of lectures, expert panel discussions and papers has been planned. For more information, contact the Congress organiser Ken Richards at Excel Solutions. Tel: 083 753 2937. Fax: 086 671 4444. Email: firstname.lastname@example.org
The Biennial Congress of the South African Podiatry Association took place this last weekend.
The first two days were a Biomechanics Boot Camp taught by renowned Australian podiatrist Craig Payne and today there were presentations by local podiatrists on rheumatology, diabetes, paleo-anthropology and education.
Most podiatrists routinely perform biomechanical examinations on their patients – but this Boot Camp was something else – it has changed my thought paradigms and will alter the way I examine my patients and any orthotic treatment I decide to use. (I know this is true for every one else who attended the Boot Camp).
There was another interesting development at the Congress, I was elected Chairman of the South African Podiatry Association for the next two years.
This is a real privilege and challenge as podiatry in South Africa needs to have a much higher profile and take a more prominent place in the South African health care scene.
Expect to see much more about feet and foot care in the future.
Fame is a passing thing, but all things come to those who wait! The Rheumatology Updates were originally planned for Febuary in Nairobi, Kenya. My ego was nicely polished by being invited to participate as a speaker at a 3-day workshop for Allied Health Professionals. The trip to Kenya was postponed twice due to the political unrest in that country. However last Wednesday I received confirmation that the trip is on.
The event is an initiative of AFLAR (African League of Associations for Rheumatology). The full title is The Regional Rheumatology Symposium and Workshops, Eastern African Region “Rheumatology Updates.”
Running from the 6th – 10th October there is a 3-day workshop for Allied Health Professionals, a Public Lecture (to be presented at the Holy Family Basilica Hall -the Cathedral) and the Rheumatology Updates will take place on the 8th & 9th at the Grand Regency Hotel.
I have to give three oral presentations plus two practicals at the workshops and (here’s the ego polish!) I have been invited to speak at the more formal updates on The Foot in Arthritis.
As far as I am aware, there is only one qualified Rheumatologist in Nairobi – possibly in Kenya. When I went there last year as part of a team from the Department of Rheumatology from the University of the Witwatersrand, for an AFLAR Congress, the hunger for knowledge was immense, but the resources very few. The intention is to not only impart knowledge but also to train people to provide better care to people with Arthritis.
I have also found out that there is only one podiatrist in Kenya too. A graduate of the University of Salford. Quite by coincidence I was a lecturer there in the 1970’s.
Sorry for the silence and lack of input to the site for the past month. Reasons? My associate got married and was on honeymoon, so I had to work harder! The winter respiratory dryness got me and I succumbed to a chest infection. Also got in a brief visit to my granddaughter in Hout Bay and the biggest time taker of all was setting year end examinations for the podiatry students at the University of Johannesburg.
However I can’t wait for the Rheumatiology Updates in Nairobi. As I said “fame at last, an ego polished and silence broken”.
Fresh from the long weekend we welcome Ms Lauretta Zikalala to our podiatry practice. Lauretta is our new receptionist and will be the voice of the practice from today. Back at the practice today, (not exactly fresh!) after a tiring but stimulating weekend at the Diabetic Foot Working Group (DFWG) Congress. Armed with some new knowledge and revision of existing, Tshidi and I feel that we have more to offer our patients with diabetes.
We know that Podiatry and diabetes is not just about managing the serious complications such as foot ulcers. The key issue is the prevention of this complication and research shows that multidisciplinary interventions can reduce both ulcers and amputations. There is a major challenge in South African health care to educate everybody involved in diabetes about the need for proper foot health care.
Just to get patients and professionals to look at feet could prevent many complications. So many patients do not feel pain and are therefore misled into thinking that there is nothing wrong with their feet. Meanwhile they develop blisters from footwear, ulcers from objects like drawing pins, stones and other foreign bodies and burns and scalds from heaters or hot water. It is clear that we will have to develop innovative and cost effective interventions to reduce the numbers of amputations and to improve foot health awareness in South Africa.
For any health professionals reading this; do you know what an angiosome is? I’ll publish some references tomorrow. (I think you will be amazed). For the lay person, angiosomes allow vascular specialists and podiatrists, in the context of patient examination, to accurately assess the quality of blood flow to every part of the lower limbs and feet. This enables really accurate identification of those areas at risk due to inadequate blood supply. Most of us are familiar with the dermatomes which map out the nerve supply, but angisomes are something new. (Well they are to me!).
Tomorrow morning sees the start of the first Diabetic Foot Working Group (DFWG) Congress in Johannesburg. In South Africa it is also a long weekend – meaning that Monday June 16 is a National Holiday, when we remember the youth of SA and their part in the struggle against apartheid. Especially the riots which broke out on June 16 1976.
For those of us dedicated to another great cause, we will spend the next 3 days learning, sharing and discussing the causes and effects of the diabetic foot, with a special emphasis on our local problems and solutions. We have speakers from Cameroon, the UK and USA, in addition to a variety of local speakers. The benefit of this type of congress is that you get to meet the members of the wider multidisciplinary team and the exchange of ideas and information will help to increase the core of health professionals available to manage the feet of people with diabetes in South Africa.
Recently I have been requested to try to assist with the development of training in foot health in Nigeria and have a new contact with an orthopaedic surgeon in Iraq. There are no podiatrists in Nigeria at all, where the population is more than 140 million. Furthermore there is no government support for foot care either.
I am very pleased to report that the lady featured in the ‘bean bag’ blogs, is making fantastic progress, thanks to the skill of my associate Tshidi Tsubane. We are also very proud of the fact we have had a paper published in a new journal – Wound Healing Southern Africa – Volume 1 No 1. visit www.woundhealingsa.co.za
Currently we are working onpapers concerning nail surgery for people with diabetes and the costs of ulcer care from a podiatrist.
Finally for Friday 13th! I spent the day as an examiner for the podiatry students at the University of Johannesburg. I’m not sure who was more tired the students or me. At the end of two sessions of assessing competency in clinical skills you actually feel quite sorry for them.
Have a great weekend.
June 14,15,16 are landmark dates in the history of diabetic foot care in South Africa.
The Diabetic Foot Working Group (DFWG) is holding its first congress. Noted overseas speakers will be Professor Andrew Boulton (Miami and Manchester) and Dr Zaheer Abbas from Tanzania.
This will be the first truly multidisciplinary diabetic foot meeting to be held in South Africa.
More information from www.DFWG.co.za
Approximately 120 of South Africa’s podiatrists gathered at the Indaba Hotel, Fourways, Johannesburg from Friday 6th to Sunday 8th July. Definitely the highlight of the SA podiatric calender!
The conference showed just how far Podiatry has come in recent years – despite the small number of registered podiatrists in the country – in providing quality foot care to the people of South Africa. For example; Podiatrists are developing into specialists in many areas of foot care and are working as key members of multidisciplinary teams in Sport – treating foot pathologies, researching biomechanics and understanding new footwear technologies. Their role in managing the Diabetic foot was confirmed. Research into the foot problems associated with Arthritis is developing. The field of Footwear design and manufacture is being influenced by podiatrists.
Papers were presented on Professional Ethics, Vascular Disease, Rheumatology, the Biomechanics of Cycling, Footwear sizing, the Diabetic Foot, Foot Surgery, Foot Biomechanics and Neurology.
A great weekend where new information was presented, ideas exchanged and practice enhanced.
In February this year I was in Nairobi to present a paper at the African League Against Rheumatism Conference. Following is an abstract of the paper that I presented.
PODIATRIC INTERVENTIONS FOR RHEUMATOID ARTHRITIS PATIENTS ATTENDING A TERTIARY HOSPITAL – A CLINICAL AUDIT
EAM Clarke and M. Tikly.
Introduction: Feet are commonly involved in rheumatoid arthritis (RA) but foot pain and disability as a whole are not well-understood. It has been suggested that the African foot with RA, shows increased rearfoot rigidity, with the forefoot retaining more mobility. In an unpublished study of 40 patients attending our hospital arthritis clinic, Phala (1998), reported 100% foot problems, with interventions of footwear in 80%, orthotics in 50%, and corn and callus reduction in 62.5%. The purpose of the present study was to identify and document the extent of foot problems and to identify and analyse the podiatric interventions.
Methods: Hospital records of 99 patients with RA were reviewed to identify the nature and extent of foot problems and the podiatric interventions for these patients.
Results: The mean age and disease duration were 52.4 and 11.5 years, respectively. Gender distribution was female 83 and male 16, a ratio of 5: 1. 80 (81%) patients had deformity, of which 59% were toes, 30% bunions, 47% hallux abducto valgus and 36% involved the whole foot. (Pes planus, pes cavus and metatarsus adductus). Pain was described by 49% of patients, with 52% of these being metatarsalgia, 3% heel pain and 29% ankle pain.
Podiatric interventions n=99 %
Treatment 49 49
Footwear given 7 7
Padding 43 43
Insoles 43 43
Orthotics 11 11
Foot health advice 57 57
Ulcer care 3 3
Conclusion: As part of the team approach to RA, podiatric interventions have an important role and are required by a high percentage of patients. The aim is palliation, pain relief and improvement of function and should utilize the entire range of interventions available.
Woodburn.J., Helliwell.P.S. (1997) British Journal of Rheumatology.Vol.36.(9). 932-934
Woodburn et al.(2002) Journal of Rheumatology. Jul:29(7): 1377-83
Young et al. (1991) Diabetic Medicine. 9: 55-57