Orthopedic Shoes Research Articles

An atypical and bilateral presentation of Charcot foot disease

BackgroundCharcot neuropathic osteoarthropathy (CNO) is one of the most devastating complications of neuropathy in patients with diabetes. Establishing diagnosis of CNO is difficult, due to the lack of clear clinical and radiological diagnostic criteria. Diagnosis is even more difficult when there is atypical and bilateral clinical presentation. Since CNO may lead to foot deformity, lower-extremity amputation and significant decrements in quality of life, it must be detected and treated without delay. Treatment focuses mainly on interruption of the inflammatory process and relief from pain using feet offloading devices. In more severe cases, surgical intervention may be needed. Additionally, the use of custom-made insoles and custom-made orthopaedic shoes is mandatory.Case presentationWe report a case of a young diabetic patient who presented to our clinic with bilateral and atypical presentation of Charcot foot disease. Patient was treated successfully upon diagnosis with bilateral aircast offloading. Unfortunately, due to depression and non-compliance, the disease progressed to severe and permanent lesions later on.ConclusionDespite the rareness of this disease, clinicians must include CNO into differential diagnosis of diabetic foot oedema, inflammation and deformity.

Fabrication of medical footwear for suitable distribution of stress and strain and reduction of plantar pressure by numerical and experimental approaches.

Medical insoles and orthopedic shoes are responsible for reducing the force exerted by the ground to the plantar region of the feet. This combination is designed to develop a suitable distribution of stress and strain in the plantar region. In the present study, attempts have been made to design a prototype of medical footwear which can provide a proper stress and strain distribution in the plantar region while reducing pressure in comparison with current orthopedic footwear. For this purpose, the hyper-elastic behavior materials, including styrene-butadiene rubber, silicon, Plastazote foam, polyfoam, ethylene-vinyl acetate foam, polyurethane foam, and polyurethane, have been investigated, with different degree of hardness as well as one layer of composite with Kevlar fiber, whose effect is reducing the pressure exerted to the feet. A combination of materials was used to construct an insole sample, and uniaxial pressure tests were performed for testing its mechanical properties. Then, these properties were used in finite element analysis, whereby the best type of insole for the footwear was chosen and fabricated. The results of finite element analysis were validated using Pedar system and after performing the experimental tests both statically and dynamically. Experimental and numerical investigations suggested that the sole material of orthopedic shoe should be selected as styrene-butadiene rubber. The internal layers of styrene-butadiene rubber frame from top to bottom should be comprised of Plastazote-polyurethane with Kevlar fiber-silicon shore A6, which can be a suitable orthopedic boot in terms of proper stress and strain distribution. Generally, it could reduce the pressure exerted to the sole by 79% compared with barefoot.

Choosing the target wisely: partial tibial nerve transfer to extensor digitorum motor branches with simultaneous posterior tibial tendon transfer. Could this be a way to improve functional outcome and gait biomechanics?

The objective of this study was clinical assessment of the reduction of pathological motor phenomena with the recovery of long toe extensors, and evaluation of functional outcome with simultaneous nerve and tendon transfer in cases of common peroneal nerve (CPN) injuries. Seven male patients (mean age 26.4 years) received a partial tibial nerve transfer to the extensor hallucis longus muscle (MEHL) and extensor digitorum longus muscle (MEDL) motor branches, after a mean of 2.7 months following a traction-type injury to the CPN. Tibialis posterior muscle (MTP) tendon transfer through the interosseous route was performed on the same day. The follow-up period included a clinical neurological examination, a modified Stanmore System questionnaire (MSSQ), electromyographic examination of the interference pattern, and a video-based analysis of the gait biomechanics in the 3rd and 12th months. Video analysis of the gait investigated the presence or reduction of "stair-climbing maneuver" (SCM), foot slap (FS), and foot stability during the gait cycle. The average range of active dorsiflexion in the 3rd month was 0.85°. SCM accompanied walking in 6 patients (86%). FS accompanied walking in 3 patients (43%) and 3 patients (43%) avoided FS by planting the entire foot on the ground. All patients required orthopedic support (shoe inserts) to compensate for mediolateral foot instability. The average MSSQ score was 80.4 points. The average duration for the effective recovery of function (≥ 4 points on the Medical Research Council grading system) of long toe extensors was 11.2 months. The average range of active dorsiflexion in the 12th month increased to 4.4°. A reduction of FS was observed in 5 patients (71%). Excessive foot eversion was reduced in 4 patients (57%). Another 3 patients (43%) required no specific orthopedic shoe inserts. Reduction of pathological motor phenomena with recovery of the long toe extensors resulted in an increase of functional outcome. The average MSSQ score after 12 months was 92.4 points. Partial tibial nerve transfer to the motor branches of the extensor hallucis longus and the long toe extensors along with the simultaneous tibialis posterior tendon transfer produce the reduction of FS and bring mediolateral stability to the foot, i.e., improved gait biomechanics. The reduction of pathological motor phenomena at the time of recovery of the long toe extensors is reflected in an increase in patients' functional perception of the injured lower extremity during daily walking.

Effects of new orthopedic high-waist shoes on preventing foot drop deformity among spinal cord injury patients

Objective To explore the effects of new orthopedic high-waist shoes on preventing foot drop deformity among spinal cord injury patients with lower limb paralysis. Methods From April 2016 to January 2018, we selected a total of 44 spinal cord injury patients with paralysis. All of the patients were divided into experimental group and control group according to the order of admission and random number sampling approaches. Patients of experimental group wore new orthopedic high-waist shoes from the first day after admission, while patients of control group used the square soft pillow in foot. We compared the incidence of foot drop deformity among patients two weeks after admission. Results The incidences of foot drop deformity, pressure injury on foot as well as strephenopodia of patients in experimental group and control group were 18.2% vs. 40.9%, 4.5% vs. 18.2% as well as 27.3% vs. 59.1% respectively with statistical differences (P<0.05) . Conclusions Early use of new orthopedic high-waist shoes can effectively prevent foot drop, protect function of ankle joint and promote the rehabilitation of neuromuscular function in limb among spinal cord injury patients with paralysis. Key words: Innovation promotion; Spinal cord injuries; Paraplegia; Rehabilitation nursing; Foot drop; Orthopedic high-waist shoes

Using orthopedic shoeing for the treatment of cows with sole ulcers

Using orthopedic shoeing for the treatment of cows with sole ulcers

지체장애인을 위한 여성용 정형 신발 유형 분석 연구 - 족부 질환 장애를 중심으로 -

지체장애인을 위한 여성용 정형 신발 유형 분석 연구 - 족부 질환 장애를 중심으로 -

Association between preoperative dynamic plantar pressures and clinical outcomes at 6 months after hallux valgus surgery

BackgroundThe influence of preoperative plantar pressures on clinical outcomes following hallux valgus surgery has not been yet established. This study aimed to assess the relationship between preoperative dynamic plantar pressure measurements and clinical outcomes following hallux valgus surgery. Material and methodsA prospective cohort study where patients attending the foot and ankle unit between 2016 and 2017, diagnosed of hallux valgus requesting surgical correction were recruited consecutively and preoperative plantar pressure were measured. At 6-months after surgery, the foot condition and foot pain were measured, through the American Orthopedic Foot and Ankle Society Score (AOFAS), and using Visual Analog Scale (VAS), respectively. A multivariate logistic model was used to estimate the magnitude of the associations between the explanatory variables and outcomes. Results114 patients were included in the study. Significant differences between patients with and without pain at 6-months after surgery were found in mean force on first toe, peak pressure on third and fourth metatarsal head, and maximum force on fourth and fifth metatarsal head (p<0.05). The multivariate logistic model showed significant association between the preoperative peak pressure on fourth metatarsal head (OR:0.996, p=0.003), walking (OR:7.430, p<0.001), orthopedic shoe after surgery period (OR:0.754, p=0.019) and preoperative AOFAS (OR:0.947, p=0.006), and the appearance of pain at 6-months after surgery. ConclusionThe presence of pain at six months after surgery was significantly associated with the preoperative peak pressure under the fourth metatarsal head.

Experience of finding footwear and factors contributing to footwear choice in people with gout: a mixed methods study using a web-based survey

BackgroundGout frequently affects the foot, particularly the first metatarsophalangeal joint. People with gout commonly wear ill-fitting footwear that lacks cushioning and support, which may further contribute to foot pain and disability. Footwear with good cushioning and motion control may be an effective non-pharmacological intervention. Currently, there is limited understanding about the footwear experience in people with gout. The aim was to understand footwear characteristics, experience of finding footwear, and factors contributing to footwear choice, in people with gout.MethodsA web-based survey of people visiting a gout education website. Participants self-reported a diagnosis of gout. The 17-item survey included questions to elicit demographic and clinical characteristics, type of footwear worn, level of difficulty finding appropriate footwear, and factors contributing to choices about footwear. A mixed quantitative and qualitative methodology was used to report survey findings.ResultsSurvey respondents (n = 83) were predominately White/Caucasian (84%), male (58%), and aged between 46 and 75 years-old (73%). Thirty-nine percent were newly diagnosed (< 12 months), 43% had gout for 1–10 years, and 19% had disease over 10 years. Gout flares in the feet were reported by 77 (93%) respondents, mostly in the big toe joint (73%). Seventy-six (92%) participants completed questions about footwear. Closed-in athletic shoes (88%), sturdy walking shoes (79%), and casual closed-in slip-on shoes (63%) were most frequently worn. Orthopaedic shoes were worn least often (16%). Comfort, fit, support, and ease to put on/take off were the features most often rated as important or very important when choosing footwear. Over half the respondents (64%) reported difficulty in finding footwear. Three categories, encompassing seven subcategories, were identified from the qualitative analysis to describe experiences of footwear. Categories included difficulty finding suitable shoes; impact of shoes on activity; and preferred footwear.ConclusionsPeople with gout need comfortable shoes that conform to the foot, have a wide opening, made from pliable materials with adjustable straps. The main barriers related to footwear include difficulty finding shoes that are wide enough, suitable for work and aesthetically pleasing. These findings provide clinicians with important insights into the priorities and needs of people with gout that should be considered when developing footwear interventions.

Assessment of distribution of plantar pressures and foot characteristics during walking in pregnant women.

The main purpose of this research was to analyse the distribution of plantar pressures and foot characteristics during walking between weeks 27 and 36 of pregnancy. The secondary purpose was to test the effect of the customized orthopaedic shoes that were worn by the experimental group. Pregnant women (n = 73) were divided into 2 groups, control group (n = 38) and experimental group (n = 35) which completed 5 gait trials on a walkway (1.55m) at a self-selected velocity of gait, where force, pressure and remaining foot characteristics were sampled and displayed by Novel database pro m (version 25.3.24). Analysis of foot characteristics did not reveal important changes. Analysis of the distribution of plantar pressures revealed few changes in the pre- and post-measurement of the experimental and control groups between weeks 27 and 36 of pregnancy. In the last measurement, there is a significant increase of peak pressure only in the midfoot area of the left foot (151.1 ± 41.2 kPa) and in the hindfoot area of the right foot (346.3 ± 104.1) of the experimental group. The control group exhibits similar pressure development for both of foot. Monitored parameters demonstrated in certain areas notably development of force and contact area. Results of foot characteristics did not reveal a significant changes. As both groups registered similar values in certain areas in a comparison of pre/post measurement characteristics, the influence of specific orthopaedic shoes cannot be conclusively demonstrated in the experimental group.

Assesment of commercially available children’s orthopedic footwear

Background. The term “orthopedic shoes” becomes an advertisement through which manufacturers promote their products to the market. Parents face the problem of selecting shoes that ensures normal function and development of the child’s foot. In this regard, the situation must be understood.&#x0D; The aim of the study is to identify the conformity of the footwear design and the parameters of special orthopedic parts to the requirements of the current regulatory and technical documentation for footwear for specific deformation as well as to obtain information regarding consumer information on the indications and contraindications of the designation of children’s shoes, set out in the leaflet regarding the use of shoes with special orthopedic parts.&#x0D; Materials and methods. This study was based on the results of a study of 23 pairs of 155-size children’s shoes. The shoes were selected by random sampling from the assortment that is in retail sale. The research was performed by the staff of the Federal State Institution Federal Scientific Center for the Rehabilitation of the disabled named after G.A. Albrecht of the Ministry of Labor of Russia, which are the developers of the national standard (R 544072011 “Orthopedic footwear. General technical requirements”).&#x0D; Results and discussion. The research data showed that virtually all footwear examined was manufactured in violation of the current regulatory and technical documentation. Shoes that go to free sale for selection under the guise of “orthopedic” shoes have a very attractive appearance (seen by the design and bright colors). However, such footwear does not provide the performance of medical purposes because special orthopedic parts have parameters that do not meet the requirements of national standards.&#x0D; Thus, uncontrolled implementation of orthopedic footwear for selection is unacceptable. In this regard, children without pathology of the foot and musculoskeletal system should wear standard footwear without special details. Children in need of orthopedic footwear should wear shoes strictly according to the doctor’s prescription, considering the individual anatomical and functional features of the child’s foot.

Articulated abducted hip brace and the method of its use in children with spastic paresis

Rehabilitation of patients with spastic paresis with restora­tion of walking function is an actual problem. There are more than 23 000 children with cerebral palsy in Ukraine, morbidity — 0.15 %, prevalence — 2.62 %. The main reason of severe hip instability in children with cerebral palsy is muscular imbalance with flexion and adduction contracture in the hip joint. Bracing is one of the prophylaxis and treatment method.Objective: to determine the feasibility of abducted hip braces in children with spastic palsy accompanied with rehabilitation measures.Methods: we used articulated abducted hip brace which consists of lumbar sleeve with double front bandage, individual hip cuffs, and articulated femoral rack with diameter of 8 mm, knots for adjusting the position of the hip cuffs and abducted racks. The basic effect of the brace is to reduce the hypertonicity of adducted muscles, due to this it is possible to abduct the femur, align the body, to provide hip extension. Abducted hip brace provides hip joint stability, normalize distribution of pressure between the femoral head and acetabulum, and decreases the probability of femoral dislocation in two times. We present the order of brace usage. Clinical assessment of its efficacy is made in 49 patients.Results: the best effect of the treatment patients have got in cases of combination of abducted hip brace with orthopaedic shoes or ankle joint and feet braces.Conclusions: articulated abducted hip brace allows to correct body posture and to decrease muscles spastic. It is possible to extend hip joint and align the body, femur and crus muscles begin to load, it is important for reliable body support.

Rheumatism operations in a state of flux-"Foot"

Surgical management of rheumatic feet has dramatically changed over the last decades influenced by the development of new pharmacological drugs and tissue-preserving surgical procedures. It has switched from joint resection to joint-sparing procedures as the method of choice. Nevertheless, the surgical interventions commonly used for non-rheumatic patients cannot be applied to rheumatic patients without reflection: in addition to the basic treatment, comorbidities, degree of mobilization of the patient, orthopedic shoe engineering and orthotic treatment play amajor role. Due to the decreasing incidence of the classical rheumatic foot, it has become even more important for physicians, physiotherapists and ergotherapists to recognize the development of such a disease as early as possible and immediately start the appropriate treatment.

Comparison of Quality of Life, Satisfaction with Life, and Satisfaction with Orthopedic Shoes among Veterans with Lower Extremities Length Discrepancy Receiving Services and Not-receiving Services after Two Years of Follow-up

Comparison of Quality of Life, Satisfaction with Life, and Satisfaction with Orthopedic Shoes among Veterans with Lower Extremities Length Discrepancy Receiving Services and Not-receiving Services after Two Years of Follow-up

Issues of conservative treatment of patients with flatfoot

Flatfoot is the most common foot disease, the prevalence of which is 30-70% according to many authors. Planovalgus foot deformity asymptomatically existing for a long time can further lead to pain syndrome and limping, sensitivity disorders, trophic disorders, limitation of foot joints mobility, development of arthritic changes with corresponding progression of the function impairment. Timely initiation of treatment, complex pathogenetic and symptomatic therapy as well as strict adherence to the doctor's recommendations help to achieve maximum effect. The aims of treatment of patients with flatfoot are posture stabilization and support of overloaded zones of the plantar surface, improvement of supply of the foot and musculoskeletal apparatus, as well as foot joints, and reduction of pain syndrome. Despite the prevalence of pathology, as well as a wide range of methods of treatment and rehabilitation, conservative treatment does not always lead to a positive result and the problem remains unresolved. This literature review describes the main directions of conservative therapy of patients with flatfoot from the view of evidence-based medicine. The data on the use of special ortheses and orthopedic shoes for correcting the foot deformities are discussed with a description of possible complications. The main forms of exercise therapy used to stabilize the foot muscles tonus, are analyzed. The application of physiotherapeutic factors aimed at improving trophic and blood supply of tissues, as well as strengthening of the musculoskeletal apparatus of the lower legs and feet, is described. Data on the use of complex conservative treatment of patients with flatfoot are presented. The article also focuses on the use of drug therapy as part of the complex treatment.

New progress in the treatment of chronic wound of diabetic foot

Diabetic foot is one of the serious complications of diabetic patients. It is caused by diabetes combined with different degrees of lower extremity vascular lesions and neuropathy, and the wound can not heal for a long time. The serious results can cause bone marrow infection, bone destruction, and have high disability and death rate. At present, there are various treatment methods for diabetic foot chronic wound. On the basis of internal medicine controlling blood sugar, anti infection, lowering blood lipid, improving microcirculation and nourishment nerve, the surgical method is adopted, including the debridement of the necrosis in a short time to prevent the infection from spreading; maggot biological debridement and ozone chemical debridement will promote the growth of granulation tissue while controlling infection. Skin grafting, skin flap transplantation, skin distraction closure can be used to repair soft tissue defects, or fat transplantation, platelet-rich plasma, and rich blood are used for the refractory wound after infection control. In patients with diabetic foot, the reconstruction of lower limb blood supply is beneficial to the recovery of chronic ischemic wounds. It is feasible to improve the blood supply of the lower extremities, improve the blood supply of the lower extremity artery bypass grafting, and improve the microcirculation of the peripheral vessels around the lower extremities. Lower extremity vascular bypass pressure perfusion therapy for vascular network expansion, tibia lateral moving technique for lower limb microcirculation reconstruction. For diabetic foot ulcer caused by peripheral neuropathy, such as Charcot foot, while the application of external fixator, total contact cast technology of affected foot for reducing treatment to promote wound healing; the preparation of orthopedic shoes can play a maximum protective effect on the healing of diabetic foot wound healing.

Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis

BackgroundFoot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands.MethodsThe recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed of 2 patients and 22 experienced professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, and researchers) in the Netherlands. For each developed recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7.ResultsIn total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%.ConclusionsThese are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA.

Handicap in adults with arthrogryposis is severe, partly invisible and varies by genotype

To understand the nature of the handicap of adults with arthrogryposis multiplex congenita (AMC), a rare disease spectrum characterized by at least two joint contractures at birth in different body areas, and analyze its possible variation by genotypes. Retrospective analysis of data for unselected persons with AMC referred to the French center for adults with AMC from 2010 to 2016. All underwent a pluri-professional systematic and comprehensive investigation of deficits, activity limitation, and participation restriction according to the International Classification of Functioning, Disability and Health and genetic analysis when indicated. Participants were divided by Amyoplasia and other AMC types. Mean (SD) age of the 43 participants (27 females) was 33.2 (13.4) years; 28 had Amyoplasia and 15 other types of AMC. Beyond joint stiffness, deformities and muscle weakness, the well-known core symptoms that we quantified and for which first-line treatment involved technical aids for 50% (wheelchair for 35%, electrical wheelchair 28%, manual wheelchair 7%, crutches or orthopedic shoes 14%) and human aid for 40%, requiring technical aids more frequent with Amyoplasia than other AMC types (61% vs. 27%, P = 0.05). Other less visible disorders that could contribute to severe participation restriction were particularly pain (91%) and psychological problems including anxiety, fatigue, difficulty in sexual life, altered self-esteem, and feelings of solitude. Severe respiratory disorders were infrequent and were linked to PIEZO2 mutations (only in other AMC types), respiratory function was better with Amyoplasia than other AMC types (FVC 3.8 [3–4.3] vs. 2.2 [1.4–2.7], P < 0.001). Gait disorders were not due to respiratory impairment but to skeletal problems and were always associated with Amyoplasia when severe. This study describes disability patterns of a cohort of adults with AMC by genotype. The handicap of adults with AMC is influenced by genotype, with an important invisible handicap.

Determination of the influence of the tape tension and the detachment force of the Velcro fastener in the rehabiliation footwear

The object of research is the constructive parameters of orthopedic postoperative footwear, which are based on complex theoretical and experimental studies of the effect of the upper outer surface of the foot on the top of the footwear during using. One of the most problematic places is the lack of knowledge of the conditions of interaction of the supporting belts with the Velcro fastener and the outer part of the freebie. It is needed to ensure the operational reliability of shoes. In the course of the study, graphical dependencies of the change in the force of pressure on the upper part of postoperative orthopedic shoes were used when bending the sole as a function of the inclination angle between the tangent to the foot of the footwear and the support area. The forces of load R on the upper end of the postoperative orthopedic footwear are determined when the forces of friction between the lateral surfaces of the freebie and the external lateral sides of the foot are neglected. In this case, the problem is reduced to the construction of the equilibrium equations of the plane system of forces. As the practice of using the Velcro fastener shows, with the increase of the tension of the supporting belt (with the loops), the force of detachment in the beginning increases to some maximum, and then, with increasing tension, the force of detachment decreases practically to zero. This circumstance may affect the reliability of the connection of the tops of orthopedic footwear. To ensure the strength of the fastener, it is necessary to choose the type of fastener, the width and the length of the active coupling area, the density of the hooks, which will ensure the reliability of the fastener in the shoes. The optimal design features and the greatest value of the pressure force on the upper part of postoperative footwear at bending of the sole observed at an angle γ=25o are obtained. This is due to the fact that the proposed material has a number of features, in particular the good density of hooks per cm 2 .

Advantages and disadvantages of interdisciplinary consultation in the prescription of assistive technologies for mobility limitations

Purpose: To explore the advantages and disadvantages experienced by professionals in interdisciplinary consultation involving the user, prescriber and technician in the prescription of assistive technologies for mobility limitations.Method: Cross-sectional study. Prescribers (N = 39) and orthopaedic technicians (N = 50), who were regularly involved in an interdisciplinary consultation completed a questionnaire about advantages and disadvantages of the interdisciplinary consultation.Results: Advantages of the interdisciplinary consultation were mentioned within all CanMEDS areas of medical practice, including better and quicker prescription of the assistive technology, shared knowledge of medical diagnosis and device possibilities, shared decision making of the device prescription and clear communication rules. Disadvantages were mentioned in the CanMEDS areas management and collaboration, including planning problems (financial) reimbursement of this type of consultation, and time efficiency. On a 10-point scale, mean (standard deviation) rates of interdisciplinary consultations were 7.9 (0.6) according to prescribers, and 7.8 (0.9) by technicians. All participants wanted to continue the interdisciplinary consultation.Conclusions: Prescribers and technicians in the field of assistive technologies for walking mobility limitations appreciate an interdisciplinary consultation. Advantages are found in all CanMEDS areas, whereas disadvantages only concern coordination. It should be encouraged to realize this kind of consultation in all situations where such technologies are prescribed.Implications for rehabilitationInterdisciplinary consultation involving the user, prescriber and technician to prescribe assistive technologies for mobility limitations has many advantages in all CanMEDS areas of medical practice, and few disadvantages, related to management and collaboration only.The disadvantages of interdisciplinary consultation, such as (financial) reimbursement by health insurance companies, have to be taken into account.Professionals in the field of ankle-foot-orthoses and orthopaedic shoes (medical specialist as prescriber and orthopaedic technician) who are involved in interdisciplinary consultation appreciate it and want to continue.

AB113. 195. Theatre shoe contamination: a contributor to prosthetic joint infection?

Background: Theatre shoes are used daily by all staff however no current guidelines exist for their hygiene and management and pose a potential threat to introducing infection to theatre rooms. This can pose a particular threat to orthopaedic theatres. Assess a sample of Orthopaedic shoes for the presence of bacteria known to cause prosthetic joint infection, difference between named and communal shoes and to establish if shoes with abundant visible spatter carry more bacteria.