Alison, David, Bryan and all,

Some of you have commented on the cost of orthoses precluding their routine
use. In the study discusssed previously, the insoles used were a flat piece
of 4mm medium density eva with a hole cut in it. In terms of direct cost,
this must be in the region of 10-50p. However, since the group of patients
in the study that received the insoles did not receive debridement or
enulceation there is a potential cost saving since this therapy requires no
use of scalpal blades or sterilization of instruments and can be performed
by podiatry assistants and/ or relatively unskilled carers. This may or may
not make it popular depending on your standpoint!

Alison asked:
>>>Is there a reason why undergraduate research cannot be published?<<<

No reason at all, and several undergraduate studies do get published after
submission and exam boards. There has to be motivation on the students part.
Unfortunately the project comes at the end of the course of study and cannot
be published until after the exam (award) board (which is right at the end
of the academic year), by then most students are looking for work and find
the pressures of full-time employment enough in their own right. I do try
and help students to publish, but there is only so much I can do. In the
case of the study above, we wanted to expand the study since the numbers
used were probably too small to draw strong conclusions (n= approx 20- I
can't remember exactly). Unfortunately, University research is driven by
funding- you can do it, if someone is willing to pay for it.

Alison continued:
>>>I did find a paper written by Wilkinson and Kilmartin (1998) in which
they state in the discussion that one would naturally assume that once the
lesion was treated using electrosurgery, further long-term protection in the
form of orthotic appliances is essential in order to prevent recurrence. The
study clearly demonstrates that most people did not use such appliances,
even in the group where treatment was completely effective.
I should add that the results showed that after 55 months follow up 53%of
lesions failed to resolve, 12% partially resolved and 35% resolved.<<<

So what we are saying is 65% did not resolve. In my experience it is not the
appearance of corns that patients are concerned about, it is the pain
associated with them. Now, what happened to the pain in this 65% of
patients? How does this resolution rate (35%) compare with other therapies
and/or placebo? What is the cost of electrosurgery (to patient and
clinician) compared to other therapies?

Best wishes,
Simon

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