Good MorningThank You for this opportunity to

Showcase our ServicesShowcase our ServicesShirley Bell, Band 7, Musculoskeletal and Paediatric Specialist PodiatristSheree Lyons, Band 5, Specialist Podiatrist Core Service and Tissue Viability TeamCore Service and Tissue Viability Team

• Members Event 20th April 2013• Showcase Podiatry and MusculoskeletalShowcase Podiatry and Musculoskeletal

Services – available from One Life HartlepoolHartlepool

• Overview of service, who we are and what we do? Then a bit about what I do!

• Then Sheree’s bit!• Then Sheree s bit!

C P di t C Bi h i• Core Podiatry + Core Biomechanics• Musculoskeletal (MSK) Extended Scope Practitioners

(ESP’s) Physiotherapy Podiatry Biomechanics Gait(ESP s) Physiotherapy, Podiatry Biomechanics, Gait Laboratory, Appliance Laboratory, Clinical Psychology and Orthotist Service

• Musculoskeletal ESP’s Paediatric Physiotherapy and Podiatry Biomechanics

• Diabetic Foot Screening Service and Podiatry High Risk• Diabetic Foot Screening Service and Podiatry High Risk Team / Tissue Viability Team

• Podiatric Surgery TeamPodiatric Surgery Team• Nail Surgery Team• Rheumatology Podiatry Specialistgy y p

C P di tCore Podiatry• Community and Domiciliary Treatment• Assessment and Foot Care Management Plan• Assessment and Foot Care Management Plan

(patient empowerment)• Regular foot care treatment for at risk patientsRegular foot care treatment for at risk patients• Basic Neurological and Vascular Assessment

(including Doppler)• Annual Diabetes foot checks, in conjunction with

Diabetes One Stop Shop• Wound care• Wound care

S i li t P di t CSpecialist Podiatry Care• Rheumatology Specialist Podiatrist – specialist

wound care and provision of specialist footwear andwound care and provision of specialist footwear and orthoses in conjunction with the Orthotist

• High Risk Team – advanced vascular assessment• High Risk Team – advanced vascular assessment including ABPI, patients with poor tissue viability Management and prevention of complex ulceration g p p(below malleolar level), pre and post amputation foot health management. Service centred at University Hospital of HartlepoolHospital of Hartlepool

Podiatric Surgery Team

• Nail Surgery Team – removal of toenails under local anaestheticanaesthetic

• Forefoot day case surgery under local anaesthetic –Forefoot day case surgery under local anaesthetic tibial and popliteal blocks

Core Biomechanics• Management of Biomechanical footManagement of Biomechanical foot

problems, predominantly distal to ankle.W k l id F ll P ti d• Work alongside Falls Prevention and Stroke Teams

• Based at One Life Hartlepool Podiatry Department and Ground Floor Lawson StDepartment and Ground Floor Lawson St Health Centre

Musculoskeletal Service• Highly Specialised Multidisciplinary TeamHighly Specialised Multidisciplinary Team

working at an advanced level providing assessment and management for benignassessment and management for benign musculoskeletal conditions in children and adults.

• Arthritis, upper limb problems, back pain,Arthritis, upper limb problems, back pain, gait, foot and ankle problems and pain

MusculoskeleMusculoskele• Musculoskeletal Service• Musculoskeletal Service• The MSK service provides rapid access to local services that

patients can benefit from, reducing avoidable admissions, providing t ltidi i li i i f ti t f d b th i GPexpert multidisciplinary opinion for patients referred by their GPs.

This offers an alternative to direct referral to an outpatient consultant clinicTh i d t li i l t i di ti• The service conducts clinical assessments, organizes diagnostic investigations and provides advice and treatment

• Informs and educates patients• Referral where necessary to other primary or secondary care

services

Musculoskeletal BiomechanicsMusculoskeletal Biomechanics• Complex lower limb biomechanical issues• Assessment may lead to neurological, vascular, dynamicAssessment may lead to neurological, vascular, dynamic

gait, imaging and blood investigations• Care pathways include footwear advice, stretching and

strengthening exercise programmes foot orthosesstrengthening exercise programmes, foot orthoses, steroid injections, referral to other health care professionalsO d f l i l d ESP Ph i h C• Onward referrals include; ESP Physiotherapy, Core Physiotherapy, Surgical Appliances (for footwear and above ankle orthoses such as callipers and splints), Pain p p )Management, Clinical Psychology, M.I.N.D, Orthopaedics, Rheumatology, Neurology, Dermatology, Core Podiatry and also G.P.y

F t (thi bit i i t ti !)F t (thi bit i i t ti !)Footwear (this bit is interactive!)Footwear (this bit is interactive!)•• FootwearFootwear isis oneone ofof thethe mostmost importantimportantpp

aspectsaspects ofof ourour inputinput withwith patientpatientmanagementmanagement..gg

•• MostMost ofof ourour patientspatients cancan purchasepurchasecommerciallycommercially availableavailable footwearfootwearcommerciallycommercially availableavailable footwearfootwear..

•• IfIf theirtheir footfoot oror lowerlower limblimb deformitydeformity isisse erese ere ee referrefer toto thethe OrthotistOrthotistsevere,severe, wewe referrefer toto thethe OrthotistOrthotist..

F t MUST hF t MUST h•• Footwear MUST haveFootwear MUST have•• a deep and firm heel cup, a deep and firm heel cup, p p,p p,•• a retaining strap/buckle or preferable lace a retaining strap/buckle or preferable lace

up that needs to be adjusted to secure theup that needs to be adjusted to secure theup that needs to be adjusted to secure the up that needs to be adjusted to secure the foot in the shoe, foot in the shoe, a broad low rise sole that is at least asa broad low rise sole that is at least as•• a broad low rise sole that is at least as a broad low rise sole that is at least as wide as the sole of the foot, wide as the sole of the foot,

•• a deep broad toe box.a deep broad toe box.

Gait Laboratory

Community Paediatric Service• The Service serves the populations of Hartlepool p p p

and Stockton, aiming to provide an effective and efficient service for those patients who have a clinical need. Age range 0-16 years.

• The service comprises of a team of fully qualifiedThe service comprises of a team of fully qualified professionals from the following disciplines:

• Physiotherapy• Physiotherapy• Podiatry

Procedures Performed• Biomechanics and Physiotherapy Assessmentsy py• Referral for appropriate imaging• Orthoses• Orthoses• Splints• Footwear• Exercise and Rehabilitation• Referral for surgical procedures

Inclusion/Exclusion Criteriac us o / c us o C e a• Conditions treated:• Flat feet Toe walking In

• Exclusions:• Red flags• Flat feet, Toe walking, In-

toeing, out-toeing, Gait abnormalities, Knock Knees Anterior knee

• Red flags• Neurological conditions• Developmental delayKnees, Anterior knee

pain, Bow legs, Postural problems, Spinal

bl V /V l

e e op e a de ay• Adults 17 and over• Under care of

P di t i iproblems, Varus/Valgus knees, Hip problems, Hypermobility, Upper limb

bl S t i j i

Paediatrician or Orthopaedic surgeon for a related condition

problems. Sports injuries. etc

O t MOutcome Measures• To measure the outcomes of health care

interventions the objective of care must be clear, for example:, p

• If the object of care is to reduce pain then the outcome measure is a pain scalethe outcome measure is a pain scale

• If the object of care is to improve s mptoms then the o tcome meas re issymptoms then the outcome measure is the baseline symptom severity

O t t i f ti• Our contact information

C P di t C Bi h i d S i li t• Core Podiatry, Core Biomechanics and Specialist Services contactable through the Podiatry Department Lawson St 01642 704250Department Lawson St 01642 704250

• Lead Nicola Milburn

• Musculoskeletal Service, contactable through 01429 285060285060

• Lead Susan Cantwell

Any Questions?Any Questions?