In Haringey referrals are only through GPs in the community and Consultants
in the acute unit.
All referrals in this trust are by GPs and through them physios. In the acute
unit Consultant referral only. This applies to all referrals not just
biomechanics - it is part of the "GP as gatekeeper to services provided by
primary care trusts" philosopy. The same referral criteria were developed
with and also apply in the other trust who are part of our health authority.

I see all patients and assess and provide temporary devices based on frelens
and eva wedges.

When the temporaries have produced (or not) the desired results I prescribe
custom made devices based on preforms. Currently, for functional hallux
limitus (90% of the patients I see are treated for that) I use devices based
on the Langer "Speedform" range (Rwferred to by Langer as "Chapman
Speedforms" if you wantn to ask about them). They are carbon fibre shells
with rearfoot posts to prescription and a version of the kinetic wedge
developed for me by Langer.  I don't cast for these devices, I use foamcast
boxes to make a semi-weight bearing impression - not in neutral - of the
plantar surface of the foot.  I send that to Langer and they make up the
device - affordable, quick, and at this stage of development (I have worn
them now for more than a month!) effective even on complex prescriptions.

For frontal plane custom made devices requiring forefoot post I use Instance
Systems preforms based on a shell size (See CHAPMAN,C. "Chairside orthotics -
the end of casting" Podiatry Now, April 1999). Rarely, if ever, do I have
recourse to casting for orthoses. This in community clinics with GP (and
through them physio) referrals, and in rheumatology and orthopaedic clinics
in the acute unit.

Just to reassure you about my unconventional approach, in my clinics my
discharge stats over an eighteen month period and 300 patients was 66%
symptom free, and 26% virtually symptom free at discharge. Less than 1% of
patients returned with any reoccurence or associated complaint in the year
following discharge.

I hope this helps.

Clive Chapman (020 8442 6438)

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