EMGO+ Institute, Department of general practice and elderly care medicine, VU University Medical Centre, Amsterdam, Netherlands.
J Foot Ankle Res. 2013 Aug 7;6(1):32. doi: 10.1186/1757-1146-6-32.
Foot pain is a common problem for people aged 50 and over and occurs more often in women than in men. About 60% of the foot problems are forefoot problems and slightly more than half of these patients seek medical help, mainly in the form of podiatric care. Podiatric treatment of forefoot problems is known to be heterogeneous. The aims of the present study are to describe the podiatric treatment of patients with forefoot pain and to evaluate the podiatric examination and treatment using an expert panel.
We invited twenty-five randomly selected subjects with forefoot problems who had received podiatric treatment in a pragmatic randomised clinical trial to participate in an analysis of their treatment by an expert panel. The panel retrospectively established the cause of the foot problem as well as the therapeutic goals and evaluated the treatment. These findings were compared to those reported by the treating podiatrist.
Two fundamentally different approaches were found in approach of podiatric examination; a functional approach (n =13) and a non-functional approach (n =12). In nine cases the expert panel agreed with the cause recorded by the podiatrist. In five other cases the expert panel concluded that the treatment of the podiatrist was not consistent with the cause of the problem recorded by the podiatrist. Of the 10 patients for whom the podiatrist had recorded to have given shoe advice, only two were able to recollect the proper advice. Three patients did not remember receiving advice at all.
In this study almost half of the podiatrists worked according to a non-functional approach where the other half (like the expert panel) chose a functional strategy that analyses the underlying problem. Fundamental differences in treatment plans and thus heterogeneous treatments could be a consequence.
足部疼痛是 50 岁及以上人群的常见问题，女性比男性更常见。大约 60%的足部问题是前足问题，其中略多于一半的患者寻求医疗帮助，主要是接受足病治疗。众所周知，足病治疗前足问题存在很大的异质性。本研究的目的是描述前足疼痛患者的足病治疗情况，并使用专家小组评估足病检查和治疗。
我们邀请了 25 名随机选择的患有前足问题并接受过足病治疗的患者参与专家小组对其治疗的分析。专家组回顾性地确定了足部问题的原因以及治疗目标，并评估了治疗效果。这些发现与治疗足病医生报告的结果进行了比较。
我们发现足病检查有两种截然不同的方法；一种是功能方法（n=13），另一种是非功能方法（n=12）。在 9 例中，专家组与足病医生记录的病因一致。在另外 5 例中，专家组得出结论，足病医生的治疗与足病医生记录的病因不符。在足病医生记录给予鞋类建议的 10 名患者中，只有 2 名能够回忆起正确的建议。有 3 名患者根本不记得接受过任何建议。
在这项研究中，近一半的足病医生采用非功能方法，而另一半（如专家组）则选择分析潜在问题的功能策略。治疗计划的根本差异以及因此产生的治疗方法的异质性可能是其结果。
