What the Editor is Reading
We’re frequently reminded in the print and electronic press about the epidemic of obesity in developed countries, the consequences of obesity for individual health and the impact of the epidemic on the health care system. In the most recent edition of POI, Kulkarni, Hannett, and Purcell (2015)remind us that this epidemic also impacts on prosthetic and orthotic service delivery. In their survey of prosthetic clinics in the UK, the authors found that 10% of clients exceeded the normal 100 kg weight limit for prosthetic components. The authors comment on the reduced prosthetic options available to high body mass clients and the limited functional performance of these options. In addition to the clinical problems of fitting overweight clients and the co-morbidities of obesity, it is difficult to provide a prosthetic solution which will facilitate increased activity and a return to healthy body weight. All too often, obese amputees are locked in to a vicious cycle of reduced activity, reduced fitness and increased weight.
In comparison to other allied health professions, Prosthetics and Orthotics has been slower to produce a base of high-level evidence. Only a handful of randomised clinical trials have been published in POI since 2000. It is, therefore, pleasing to see a recently accepted RCT by Gordillo-Fernández et al. (2015)in OnlineFirst. In the trial, the investigators studied the effect of foot orthoses on hallux limitus and demonstrated substantial and statistically significant improvement with a foot orthosis which included additional support under the first metatarsal head. The authors provide a rational for their treatment based on biomechanical theory and explain apparent discrepancies in the literature. In addition to the important clinical information, the article is a good example of the type of study needed to enhance the evidence base in P&O.
An unusual article in the current issue of POI presents a kinematic analysis of the playing technique of the wonderful swing jazz guitarist, Django Reinhardt, based on archival videos in YouTube (Wininger & Williams, 2015). Django suffered a burn injury in his late teens which left him with considerable scarring and flexion contractures in the phalangeal joints of his left (fret) hand. Wininger and Williams present a novel analysis method which corrects planar coordinate data from an out-of-plane camera. On the basis of their comparison of Reinhardt’s technique with other contemporary guitarists, the authors comment on the adaptation of function in his remaining fingers and draw implications for prosthetic hand design. The article is a poignant reminder of the ability of people with physical disability.
- Gordillo-Fernández, L. M., Ortiz-romero, M., Valero-Salas, J., Salcini-Macías, J. L., Benhamu-Benhamu, S., García-de-la-Peña, R., & Cervera-Marin, J. A. (2015). Effect by custom-made foot orthoses with added support under the first metatarso-phalangeal joint in hallux limitus patients: Improving on first metatarso-phalangeal joint extension. Prosthetics and Orthotics International. doi:10.1177/0309364615584659
- Kulkarni, J., Hannett, D. P., & Purcell, S. (2015). Bariatric amputee: A growing problem? Prosthet Orthot Int, 39(3), 226-231. doi:10.1177/0309364614525186
- Wininger, M., & Williams, D. J. (2015). More with less: A comparative kinematical analysis of Django Reinhardt's adaptations to hand injury. Prosthet Orthot Int, 39(3), 238-243. doi:10.1177/0309364614523173