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There is increasing use of digital technologies in urban planning, including in the generation of designs and the participative side of planning. We examine this digital planning by reporting on the application of an experimental online participatory platform in the regeneration of a London housing estate, enabling reflection on participation processes and outcomes. Drawing on lessons learned, the paper synthesises a conceptual representation of online participation and a relational framework for understanding the participatory platform and its context. We subsequently develop a ‘matrix of participative space’, building on Arnstein’s ‘ladder of participation’, to present a two-dimensional framework of online participation, identifying cases of ‘participative deficit’ and ‘democratic deficit’. We conclude with implications for future digital participation in urban planning and design.

Introduction/Purpose: The aim was to compare different bone marrow stimulation techniques and consequent fluid permeability of subchondral bone by assessing flow of radiopaque contrast agent using μCT image analysis and 3D modelling. Methods: Donated human tali specimens (n=12) were prepared by creating separate matched 10mm diameter chondral defects in each. Each defect underwent one of three surgical techniques: fine wire drilling, nanofracture or microfracture, addition of radiopaque contrast agent and imaged using a clinical μCT scanner. Using Slicer 3D software each μCT scan was segmented for bone and contrast agent regions in each surgical site of each sample. Each site was resolved into a cylinder and the ratio of segmented pixels of contrast agent against bone calculated. Results: μCT analysis indicated that 8/12 nanofracture regions demonstrated enhanced flow of contrast to at least the depth of the fracture site, with some additional lateral flow also observed. 8/12 microfracture regions demonstrated flow of contrast agent localised to the fracture site and preferential flow laterally. Only 1/12 samples with fine wire drilling demonstrated any fluid flow. In 11/12 samples that showed no permeation of contrast agent, a residual layer of contrast agent on the chondral surface was seen. Segmentation of each sample site showed a significant increase (n=12, p< 0.05) in fluid flow of the contrast agent in the nanofracture sites (11%) compared to microfracture (5%) and fine wire drilling (2%). Conclusion: Nanofracture showed significantly improved fluid permeability throughout the surrounding trabecular structure, when compared to microfracture and fine wire drilling. Microfracture allowed some fluid flow, but only confined to the immediate area around the fracture site, while fine wire drilling allows very little fluid flow at all. This study suggests that nanofracture should perhaps be the preferred mode of subchondral bone preparation for osteochondral lesions of the talus. Quantitative measurement of contrast permeability into talar subchondral bone by technique Nanofracture showed significantly improved fluid permeability throughout the surrounding trabecular structure, when compared to microfracture and fine wire drilling

Category: Basic Sciences/Biologics; Ankle; Arthroscopy; Sports Introduction/Purpose: Current surgical practice for the treatment of osteochondral lesions in the ankle involves using one of three techniques to promote blood flow from subchondral bone tissue to the defect site, improving the rate of healing. These different techniques: - fine-wire drilling, nanofracture and microfracture, involve disrupting the trabecular bone. However, the size and method of these techniques means this varies in terms of penetration depth and diameter. Additionally, each technique causes differing degrees of damage to the trabecular structure, and the ability of fluid to flow through the porous structure. The aim of this study was to compare the influence of the different techniques on the fluid permeability of the tissue following by assessing the flow of radiopaque contrast agent using μCT image analysis. Methods: Fresh-frozen cadaveric tali specimens (n=12) were prepared through creating a 10mm diameter chondral defect in three different regions of each talus. Each region then underwent one of three surgical techniques: 1) Fine wire drilling, 2) Nanofracture or 3) Microfracture, undertaken by a single surgeon.0.1 ml radiopaque contrast agent (Omnipaque TM 300) was then added to each region and imaged using a clinical μCT scanner (SCANCO Medical AG, 73.6 μm resolution) The amount of contrast agent that permeated through each different region was assessed through imaging processing. Results: The μCT analysis indicated that across the 12 samples, eight nanofracture regions demonstrated flow of contrast agent to the depth of the fracture site or deeper. Some lateral flow was also observed in these sites. Eight microfracture regions demonstrated that the flow of contrast agent was localised to the fracture site and a preferential flow laterally. In only one sample, did a fine wire drilling region demonstrate any fluid flow. In this sample, contrast agent had permeated through the drilling site to the bottom and some sub-site permeation was observed. However, in all samples that showed no permeation of contrast agent through the fracture site, there was a layer of contrast agent on the chondral surface or minor permeation through to the sub- chondral surface. Conclusion: Nanofracture showed improved fluid permeability throughout the surrounding trabecular structure, when compared to microfracture and fine wire drilling. Microfracture appears to allow some fluid flow, but this is confined to the immediate area around the fracture site, while fine wire drilling appears to allow almost no fluid flow through the surrounding trabecular tissue. This conclusion is reinforced by previous literature that concluded the damage to the structure of the trabecular tissue is reduced when using nanofracture, compared to the other two techniques.

Category: Basic Sciences/Biologics; Ankle; Ankle Arthritis Introduction/Purpose: Osteochondral lesions of the talus commonly occur because of traumatic injury. These lesions can affect the biomechanical behaviour of the ankle joint resulting in further degradation of the tissue and development of osteoarthritis. However, little is known about the impact of such lesions to the biomechanical behaviour of the natural ankle joint, in particular changes to the tribology of the joint due to their introduction. The aim of this study was to develop a tribological simulation of the natural tibiotalar joint to assess frictional changes due to the introduction of chondral lesion and to further assess the impact of current treatment modalities such as AMIC techniques (Nanofracture with Chondro-Gide membrane) and osteochondral allograft cores (OCA). Methods: A healthy left cadaveric tibiotalar joint (n =1) was cemented into a custom-made jig; to preserve centre of rotation (COR). The sample was loaded into a ProSim Pendulum Friction simulator and tested using the following loading conditions. Simulations were run at 1-Hertz frequency for 3600 cycles with a constant load of 640 N applied through the tibia through a +- 10° flexion and extension (F/E) angle. Data was normalised using a mean frictional offset value calculated through a 2-minute pre- and post-test to account for additional frictional torque and changes to friction factor was assessed. Cartilage was assessed for changes in tissue appearance and damage. Following this, a 10-mm circular, chondral defect was introduced to talar dome and testing was repeated under the same conditions. The defect was repaired with a 10-mm Chondro-Gide patch and then 10-mm OCA before being subsequently tested using the same methods. Results: No visible changes were seen to the cartilage during testing for the healthy, defected and Chondro-Gide treated conditions. Some damage could be seen on the reciprocal tibial cartilage after testing with the OCA repair. Assessment of normalised friction factors showed that while testing, for each condition, the frictional output remained stable with a reduction in the mean friction factor seen due to the introduction of a defect. This was maintained with Chondro-Gide. A return to normal was seen in the OCA treatment with the overall mean values for the healthy and OCA repair were 0.0301 and 0.0329, respectively. In addition, overall mean frictional factor values in the presence of a defect and Chondro-Gide repair showed reduced frictional values of 0.0119 and 0.0103, respectively. Conclusion: This method will allow for potential preclinical evaluation of treatments for OLTs in an appropriately simulated environment to assess tribological changes. The values obtained for the frictional factor all sit within the expected range for friction between two cartilage surfaces that has been reported in the literature 0.003 and 0.08. Thus, providing a reliable platform for comparing different methods of osteochondral defect repair in the tibiotalar joint.

Category: Basic Sciences/Biologics; Ankle; Sports Introduction/Purpose: The management of osteochondral lesions of the talus (OLTs) provides a challenging predicament for clinicians; with an increased array of treatment options available. In many cases, the management strategy used is dependent on both the size and location of the lesion. One of the current treatments used for mid-sized (10-20 mm) lesions is Chondro-Gide membrane. To apply this therapy, the defect site is debrided into a shape of the clinicians' preference with a template being used to prepare the Chondro-Gide matrix to the correct size and shape. However, there is some debate within the clinical community as to which shape allows for improved treatment. In this study we aim to assess whether a square or circular scaffold repair provided improved treatment when tested tribologically. Methods: 16-mm circular chondral defects were introduced to the talar dome of cadaveric donor tissue (n = 3). The tibiotalar joints were cemented with the centre of rotation preserved. The ankle joint was loaded into a ProSim Pendulum Friction simulator and tested using the following loading and motor conditions. Simulations were run at a 1-Hertz for 3600 cycles with a constant tibial load of 640 N and 20° sweep arc through flexion and extension. Data was normalised using a mean frictional offset value calculated using 2 minute pre- and post- test to account for additional frictional torque. Nanofracture was performed on the defect site and a circular Chondro-Gide patch was fixed using a synthetic fibrin glue before testing using the same conditions. The circular defect site was modified to create a 16-mm square defect which was repaired with a square patch in the same manner and tested as described. Results: The overall mean frictional factors over the 1-hour test for the defect, circular and square repairs were 0.039, 0.042 and 0.026, respectively. These values are within the expected range for in vitro testing of two cartilage surfaces previously reported in the literature of 0.003 and 0.08, suggesting that frictional values did not differ between the samples. However, visual changes to the stability of the repair and the reciprocal tibial cartilage could be seen post testing. In all cases the circular repair remained in the defect site. In comparison, for 2 out of 3 of the defects repaired with a square Chondro-Gide patch did not remain stable within the defect site. In both cases further delamination was seen on the reciprocal tibial cartilage tissue. Conclusion: This method will allow for potential preclinical evaluation of treatments for OLTs in an appropriately simulated environment to assess tribological changes. The values obtained for the frictional factor all sit within the expected range for friction between two cartilage surfaces that has been reported in the literature 0.003 and 0.08. Thus, providing a reliable platform for comparing different methods of osteochondral defect repair in the tibiotalar joint.

Failure Mode and Effects Analysis (FMEA) is a systematic approach for evaluating the potential failure modes in a system, and is mainly employed in three distinct tasks labelled: (1) Functional FMEA – evaluating those failures associated with product functional definition, (2) Design FMEA – analysing those failures associated with design definition and (3) Process FMEA – assessing potential failures in manufacturing and assembly processes. The literature review has shown limited works on the field of synchronising these different tasks into a working model. To address this gap, this research developed a framework for integrating these tasks of FMEAs, and then qualitatively validating the proposed framework. This research adopted a semi-structured questionnaire to collect experts’ feedback and validate the proposed framework. The t-test was then employed to evaluate the collected feedback. The findings highlight that the proposed framework is applicable and could facilitate the synchronisation of the different tasks of FMEA. This research presents a methodological approach for executing and synchronising FMEAs. Therefore, the proposed framework is practically relevant as an aid for the practitioners in catching the cascading failures and reducing the relevant impact.

Background and aim: In preparation for the Public Health England Impact Assessment of the 2014 AHP Public Health Strategy a follow up rapid literature review was commissioned. The aim was to identify primary studies in which Allied Health Professionals (AHP) contribute to public health outcomes, based on UK research evidence. This review was used to inform further UK policy and implementation for AHPs in the UK via Public Health England. Methods: A rapid mixed methods review was conducted, limiting the selection of studies to those published after December 2014 and recognising the same 12 Allied Health Professions that were used in the previous review. The rapid review included all age groups and patient populations but limited the searches to studies that reflected UK AHP practices and research outcomes. The literature search included title, abstract and full-text screening with data extraction of selected papers. A nominal group method invited expert AHPs to review and select the interventions for potential impact at population level. Results: 11 selected articles were grouped into two areas of interventions; health intervention/public health and secondary prevention/health improvement, based on the Public Health England Strategic Framework. AHP interventions were effective for Chronic Fatigue Syndrome and Osteoarthritis and specifically used to manage musculoskeletal conditions (e.g. frozen shoulder). AHPs leading vocational rehabilitation and falls management were also effective. These areas were additional to those previously identified and represented some additional specialist activity undertaken to affect health outcomes. Conclusions: This study also contributed to the UK AHP Public Health Strategic Framework 2019–2024 by appraising the UK evidence and impact of some AHP practices. Further improvement is required; for AHPs to measure the impact of their interventions which would demonstrate evidence of outcomes at population level.

Plain English summary Whilst Patient and Public Involvement and Engagement (PPIE) are widely regarded as critical to developing clinical research, there is a perception that older adults may not be able to contribute and there is less emphasis on gaining a wide range of opinions before developing research questions or projects; for example an organisational change. This PPIE initiative used three PPIE processes including existing panels and wider networking to access older adults in the community who had used the hospital services and been discharged. Older adults expressed a range of views about their experience of discharge planning and this provided an important perspective on patients’ research priorities associated with their personal independence. Efforts were taken to ensure representative views across a cross section of the population. As a result of this initial PPIE, a permanent, co-ordinated ‘elders’ panel has been established to ensure a representation of older adult views for research, service development and evaluation. This panel has permanent, fully supported members who provide reflection and feedback on any projects and programmes relating to older people’s services in the City. Abstract Background Clinical academic research and service improvement is planned using Patient and Public Involvement and Engagement (PPIE) but older PPIE participants are consulted less often due to the perception that they are vulnerable or hard to engage. Objectives To consult frail older adults about a recently adopted service, discharge to assess (D2A), and to prioritise services improvements and research topics associated with the design and delivery of discharge from hospital. To use successive PPIE processes to enable a permanent PPIE panel to be established. Participants Following guidance from an established hospital PPI panel 27 older adult participants were recruited. Participants from Black, Asian and Minority Ethnic (BAME) communities, affluent and non-affluent areas and varied social circumstances were included. Methods Focus groups and individual interviews were conducted in participants own homes or nearby social venues. Results Priorities for discharge included remaining independent despite often feeling lonely at home; to remain in hospital if needed; and for services to ensure effective communication with families. The main research priority identified was facilitating independence, whilst establishing a permanent PPIE panel involving older adults was viewed favourably. Conclusions Taking a structured approach to PPIE enabled varied older peoples’ voices to express their priorities and concerns into early discharge from hospital, as well as enabling the development of health services research into hospital discharge planning and management. Older people as participants identified research priorities after reflecting on their experiences. Listening and reflection enabled researchers to develop a new “Community PPIE Elders Panel” to create an enduring PPIE infrastructure for frail older housebound people to engage in research design, development and dissemination.

Soft tissue tumors in infants encompass an overlapping spectrum of diseases posing unique diagnostic and clinical challenges. Here, the authors investigate the genetic basis of cryptogenic congenital mesoblastic nephroma and infantile fibrosarcoma lacking the canonical NTRK3-ETV6 fusion gene, and identify therapeutically tractable intragenic rearrangements in EGFR and BRAF.

Abstract Background Peripheral arterial disease affects the lower limb and is associated with diabetes, high cholesterol, smoking and obesity. It increases the risk of cardiovascular morbidity and mortality. It can be symptomatic causing intermittent claudication, but often there are few clinical signs. Podiatrists are able to detect the presence of peripheral arterial disease as part of their lower limb assessment and are well placed to give advice on lifestyle changes to help reduce disease progression. This is important to improve health outcomes and is offered as a prevention/public health intervention. Method We describe the clinical and patient-centred outcomes of patients attending a podiatry-led integrated care pathway in a multi-use clinic situated in a venue supported by the National Centre for Sports and Exercise Medicine in the UK. At the baseline appointment, patients were given a full assessment where symptoms of intermittent claudication using the Edinburgh Intermittent Claudication Questionnaire, foot pulses, Doppler sounds, Ankle Brachial Pressure Indices, glycated haemoglobin (HbA1c) and cholesterol levels, and smoking status were recorded. A tailored treatment plan was devised, including referral to an exercise referral service, smoking cessation programmes (if applicable) and each participant was also seen by a dietician for nutritional advice. Participants were followed up at 3 and 6 months to assess any improvement in vascular status and with each completing the EQ-5D quality of life questionnaire and a simple satisfaction questionnaire at the end of the study. As this was a complex intervention a pilot study design was adopted to evaluate if the method and outcomes were suitable and acceptable to participants the results of which will then inform the design of a larger study. Results Data was collected on 21 individuals; 15 men (71.4%) and 6 women (28.6%) across the 6-month study period. Eleven participants were referred onto the exercise referral service; 16 participants saw the dietician for nutritional advice at baseline and had one-to-one or telephone follow-up at 3 months. Five out of 14 participants had reduced scores from baseline of intermittent claudication during the study period. No evidence for substantive changes in Doppler sounds or ABPI measurements was revealed. Quality of life scores with the EQ-5D improved in 15 participants; this was statistically significant (p = 0.007) with 14 participants who completed the simple satisfaction questionnaire expressing a positive view of the programme. Of the four people who were smokers, two stopped smoking cigarettes and moved to e-cigarettes as part of smoking cessation advice. Conclusion As this was a pilot study the sample size was low, but some statistically significant improvements with some measures were observed over the 6-month study. Podiatrists are able to provide a comprehensive vascular assessment of the lower limb and accompanying tailored advice on lifestyle changes including smoking cessation and exercise. Locating clinics in National Centres for Sports and Exercise Medicine enables easy access to exercise facilities to encourage the adoption of increased activity levels, though the long term sustainability of exercise programmes still requires evaluation. This study was reviewed and approved by London Brent Ethics Committee IRAS ID 204611 and received research governance approval from the sponsor, Sheffield Teaching Hospitals NHS Foundation Trust Research and Innovation Office STH19410.

Abstract Background This narrative review explores the ways in which drawing on theories and methods used in sociological work on footwear and identity can contribute to healthcare research with podiatrists and their patients, highlighting recent research in this field, implications for practice and potential areas for future development. Traditionally, research within Podiatry Services has tended to adopt a quantitative, positivist focus, developing separately from a growing body of sociological work exploring the importance of shoes in constructing identity and self-image. Bringing qualitative research drawing on sociological theory and methods to the clinical encounter has real potential to increase our understanding of patient values, motivations and – crucially – any barriers to adopting ‘healthier’ footwear that they may encounter. Such work can help practitioners to understand why patients may resist making changes to their footwear practices, and help us to devise new ways for practitioners to explore and ultimately break down individual barriers to change (including their own preconceptions as practitioners). This, in turn, may lead to long-term, sustainable changes to footwear practices and improvements in foot health for those with complex health conditions and the wider population. Conclusion A recognition of the complex links between shoes and identity is opening up space for discussion of patient resistance to footwear changes, and paving the way for future research in this field beyond the temporary ‘moment’ of the clinical encounter.

Chordoma is a rare often incurable malignant bone tumour. Here, the authors investigate driver mutations of sporadic chordoma in 104 cases, revealing duplications in notochordal transcription factor brachyury (T), PI3K signalling mutations, and mutations in LYST, a potential novel cancer gene in chordoma.

Osteosarcoma is a primary malignancy of bone that affects children and adults. Here, the authors sequence childhood and adult osteosarcomas, identifying mutations in insulin-like growth factor signalling genes and distinct genomic rearrangement profiles characterized by chromothripsis-amplification.

Table of content P3 Medial longitudinal arch development of school children Jasper W.K. Tong, Veni P. Kong P4 Is measuring the subtalar joint reliable? Lily Sze, Susie Gale, John Veto, Carla McArdle P5 Comparison of turning gait biomechanics between able‐bodied and unilateral transtibial amputee participants Thanaporn Tunprasert, Victoria Bradley, Siobhan Strike P6 Comparison of walking gait biomechanics between able‐bodied and unilateral transtibial amputee participants using a new model of energy‐storage‐and‐return (ESAR) prosthetic Thanaporn Tunprasert, Victoria Bradley, Siobhan Strike P7 An observational study of in‐shoe plantar and dorsal pressures of skilled downhill skiers on a dry ski slope Robert Ashford, Roozbeth Naemi, Nachiappan Chocklingam, Xavi de Blasc P8 If the shoe fits: a footwear choice toolkit informed by social science methodologies Lisa Farndon, Vicki Robinson, Emily Nicholls P9 The identification of emotions from gait Tabitha Birch, Ivan Birch P11 Experience of foot problems in patients with systemic lupus erythematosus Simon Otter, Sunil Kumar, Peter Gow, Nicola Dalbeth, Michael Corkill, Kevin Davies, Sam Panthakalam, Maheswaran Rohan, Keith Rome P14 Negative pressure wound therapy for the management of foot wounds in the diabetic population: a review of the literature Chloe Egan, Lisa Chandler P15 Lower limb vascular assessment in diabetes: a multifaceted assessment of objective screening techniques Peta Tehan, Vivienne Chuter, Jennifer Sonter, Sean Lanting P16 Improving outcomes for diabetes foot complications Lorna Hicks P17 Acupuncture… an alternative or adjunctive treatment option for diabetes‐related neuropathic pain? Christopher Joyce, David Watterson, Caroline McIntosh P18 “My back is in agony” – A cross‐sectional study into the relationship between musculoskeletal complaints and a whole body postural risk assessment in podiatry students Christopher Joyce, Nigel Roberts P19 Swabs of the treatment couches: Does the material type and texture of podiatric treatment couches increase microorganism contamination? Jacqueline Forss, Chrystalla Charalambous, Jack Kirby, Oluwakemi Ojo P20 Does increased exudate viscosity effect the absorption rate of exudate into four different wound dressings? Jacqueline Forss, Sarah Caukill, Jacqueline Capon, Radiance Fong, Louis Loy P21 An investigation into the microbial load of a 40 °C and 60 °C wash Matthew Diment, Madeleine Murray, Mairghread Ellis, Carla McArdle P23 The sensitivity and specificity of the toe brachial index in detecting peripheral arterial disease: a systematic review and meta‐analysis Peta Tehan, Vivienne Chuter, Christopher Oldmeadow P24 Medicines management activities and non‐medical prescribing within podiatry and physiotherapy: an integrative review of the literature Nicola Carey, Karen Stenner, Heather Gage, Jane Brown, Peter Williams, Simon Otter, Ann Moore, Jude Edwards, Freda Mold, Molly Courtenay A7.2 Non‐invasive vascular assessment in the foot with Diabetes: Diagnostic accuracy of ankle brachial index, toe brachial index and continuous wave Doppler Peta Tehan, Alan Bray, Vivienne Chuter A7.5 The efficacy of dressings on post nail surgery phenolised wounds Pamela Hindmoor B7.1 Cross‐sectional study investigating the role of proximal and distal factors in the development of patellofemoral joint pain Craig Gwynne, Sarah Curran B7.2 Podiatrist's interpretation and use of evidence in MSK practice Andy Bridgen B7.4 Predictors of falling in older podiatry patients – findings from the REFORM study Caroline Fairhurst, Dr Joy Adamson, Belen Corbacho Martin, Sarah Cockayne, Prof Catherine Hewitt, Kate Hicks, Anne‐Maree Keenan, Lorraine Loughrey‐Green, Hylton Menz, Anthony Redmond, Sara Rodgers, Jude Watson, David Torgerson, Robin Hull, Sarah Lamb, Caroline McIntosh, Wesley Vernon, Lisa Farndon B7.5 The REFORM study: Insole preference, requirements and compliance of podiatry patient's aged 65 and over and at risk of falling Lorraine Loughrey‐Green, Sarah Cockayne, Anthony Redmond, Anne‐Maree Keenan, Sara Rodgers, Lisa Farndon, Wesley Vernon, David Torgerson, Caroline Fairhurst, Jude Watson, Hylton Menz, Sarah Lamb, Robin Hull B7.6 A podiatry intervention to reduce falls in care home residents is feasible and demonstrates benefits: results from PIRFECT, a feasibility randomised controlled trial Gavin Wylie, Zoe Young, Brian Williams, Frank Sullivan, Hylton Menz, Simon Ogston, Jacqui Morris C7.1 A survey exploring footwear habits in people with stroke and people with Parkinson's Cathy Bowen, Dorit Kunkel, Mark Cole, Margaret Donovan‐Hall, Ruth Pickering, Malcolm Burnett, Dan Bader, Judy Robison, Louis Mamode, Ann Ashburn C7.2 Painful foot osteoarthritis; a common symptom in a common pathology? Peter McQueen, Maxine Daniels, Michael Doherty, Nigel Arden, Cathy Bowen C7.4 Clinical diagnosis of symptomatic forefoot neuroma in the general population: Delphi based recommendations Charlotte Dando, Lindsey Cherry, Cathy Bowen C7.5 The development and implementation of a Clinical Quality Improvement Framework suitable for use in community services Nichola Stefanou C7.6 The REFORM study ‐ methodological considerations in running a cohort randomised controlled trial within a podiatry patient caseload Sarah Cockayne, Joy Adamson, Caroline Fairhurst, Catherine Hewitt, Anne‐Maree Keenan, Sally Lamb, Lorraine Loughrey‐Green, Caroline McIntosh, Hylton Menz, Anthony Redmond, Sara Rodgers, Wesley Vernon, Jude Watson, Lisa Farndon, Belen Corbacho, Robin Hull, David Torgerson A31 Jewel in the crown: Exploring the factors contributing to the development and impact of foot problems in Systemic Sclerosis (SSc) Begonya Alcacer‐Pitarch, Anthony Redmond, Maya Buch, Anne‐Maree Keenan

Abstract Background Corns are a common foot problem affecting a large proportion of the population. This study describes the characteristics of corns experienced by 201 participants taking part in a randomised controlled trial to investigate associations between demographic and corn parameters on pain, foot related disability and quality of life (QoL). Methods Pain from the main (index) corn was measured using a visual analogue scale (VAS); foot related disability was assessed with the Foot Disability Questionnaire (now known as the Manchester Foot Pain and Disability Index) and quality of life was recorded with the EQ‐5D questionnaire. The effect of demographic and corn parameters on the pain and quality of life outcomes was assessed with analysis of variance (ANOVA) methods. The effect of the same factors on a linear combination of the foot‐related disability outcome measures was assessed using multivariate ANOVA methods. Pain was also tested for its mediating properties on the causal pathway between the independent variables and quality of life. Results The mean pain score was 5.29 points on a 10 cm VAS, with females reporting substantively higher pain levels than males. Age affected foot‐related disability, with lower levels on all domains of the MFPDI reported in older participants; each year of advancing age was associated with falls of: 0.009 points on the Concern about Appearance (CA) domain; 0.047 points on the Functional Limitation (FL) domain and 0.048 points on the Pain Intensity (PI) domain. Sex and corn type also affected disability, with higher scores reported by females and participants with plantar corns. Conclusions The effect of pain was shown to mediate the relationship between sex and foot‐related disability. The presence of plantar corns has a more detrimental effect on QoL than dorsal/inter‐digital corns. Trial registration ISRCTN 13166839

Abstract Background Amongst the many identified mechanisms leading to diabetic foot ulceration, ill-fitting footwear is one. There is anecdotal evidence that people with diabetic peripheral neuropathy wear shoes that are too small in order to increase the sensation of fit. The aim of this study was to determine whether people with diabetic sensory neuropathy wear appropriate length footwear. Methods A case–control design was used to compare internal shoe length and foot length differences between a group of people with diabetes and peripheral sensory neuropathy and a group of people without diabetes and no peripheral sensory neuropathy. Shoe and foot length measurements were taken using a calibrated Internal Shoe Size Gauge® and a Brannock Device®, respectively. Results Data was collected from 85 participants with diabetes and 118 participants without diabetes. The mean difference between shoe and foot length was not significantly different between the two groups. However, a significant number of participants within both groups had a shoe to foot length difference that lay outside a previously suggested 10 to 15 mm range. From the diabetic and non-diabetic groups 82% (70/85) and 66% (78/118), respectively had a foot to shoe length difference outside this same range. Conclusions This study shows that although there is no significant difference in shoe-length fit between participants with and without neuropathy, a significant proportion of these populations wear shoes that are either too long or too short for their foot length according to the 10 to 15 mm value used for comparison. The study has highlighted the need for standardised approaches when considering the allowance required between foot and internal shoe length and for the measurement and comparison of foot and shoe dimensions.

Abstract Background As advances in genetics are becoming increasingly relevant to mainstream healthcare, a major challenge is to ensure that these are integrated appropriately into mainstream medical services. In 2003, the Department of Health for England announced the availability of start-up funding for ten 'Mainstreaming Genetics' pilot services to develop models to achieve this. Methods Multiple methods were used to explore the pilots' experiences of incorporating genetics which might inform the development of new services in the future. A workshop with project staff, an email questionnaire, interviews and a thematic analysis of pilot final reports were carried out. Results Seven themes relating to the integration of genetics into mainstream medical services were identified: planning services to incorporate genetics; the involvement of genetics departments; the establishment of roles incorporating genetic activities; identifying and involving stakeholders; the challenges of working across specialty boundaries; working with multiple healthcare organisations; and the importance of cultural awareness of genetic conditions. Pilots found that the planning phase often included the need to raise awareness of genetic conditions and services and that early consideration of organisational issues such as clinic location was essential. The formal involvement of genetics departments was crucial to success; benefits included provision of clinical and educational support for staff in new roles. Recruitment and retention for new roles outside usual career pathways sometimes proved difficult. Differences in specialties' working practices and working with multiple healthcare organisations also brought challenges such as the 'genetic approach' of working with families, incompatible record systems and different approaches to health professionals' autonomous practice. 'Practice points' have been collated into a Toolkit which includes resources from the pilots, including job descriptions and clinical tools. These can be customised for reuse by other services. Conclusions Healthcare services need to translate advances in genetics into benefits for patients. Consideration of the issues presented here when incorporating genetics into mainstream medical services will help ensure that new service developments build on the body of experience gained by the pilots, to provide high quality services for patients with or at risk of genetic conditions.

Abstract Background Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. Methods The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. Results 1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P < 0.001, though the confidence interval indicated that the improvement was relatively small. Conclusion Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the evidence base for podiatry.