Walsh, T1, Ferris, L2, Cullen, N2, Bourke, J2, Cooney, M2, Gooi, C2, Brown, C3, Arnold, J4
1School of Clinical Sciences, Queensland University of Technology, 2Dept of Orthopaedics & Trauma, Queen Elizabeth Hospital, CALHN, SA Health, 3Dept of Orthopaedics, Noarlunga Hospital, SALHN, SA Health, 4Alliance for Research in Exercise, Nutrition & Activity, Sansom Institute, University of South Australia
Background & Rationale: People with musculoskeletal foot/ankle conditions are often referred for orthopaedic opinion, yet management prior to referral is largely unknown. This project seeks to determine the characteristics and management of musculoskeletal foot/ankle complaints prior to public-sector orthopaedic referral.
Method: People with non-urgent foot/ankle complaints were recruited over a 12-month period from waiting-lists at three tertiary hospitals in Adelaide, Australia. Participants reported their medical history and their knowledge about their complaint. Validated questionnaires measured foot/ankle pain severity and health-related-quality-of-life (HRQoL). Descriptive statistics were generated for sample demographics, medical history and foot/ankle symptoms. Multivariable regressions were used to explore factors associated with foot/ankle pain severity and whether participants considered an operation necessary.
Results: A total of 233 adults participated (38.4% response rate), 66% female, median age 57.7 years IQR 18.3, BMI 29.3 kg/m2 IQR 8.7. Half of the participants had seen a podiatrist (52.8%), while 36.5% hadn’t see any other health professional prior to referral. BMI was positively associated with foot/ankle pain severity (β=0.48, 95%CI 0.05, 0.92), while HRQoL had a negative association (β=-0.31 95%CI -0.45, -0.18). Participants told by their GP that they may need an operation were significantly more likely to consider surgery necessary (OR=31.41, 95%CI 11.30, 87.35), while older people were less likely (OR=0.94, 95%CI 0.90, 0.98).
Conclusion: More than one-third of participants hadn’t accessed allied-health care prior to orthopaedic referral and most expected to undergo surgery. The discordance between the expectation of surgery and historically low surgical-conversion rates suggests more work is necessary to improve the management of this group.
Melissa works as a Lead Clinician Podiatrist in the SALHN and CALHN networks. She coordinates an Orthopaedic High Risk Multi-Disciplinary Podiatry Clinic at Noarlunga Health Service. She has extensive experience in a high risk foot setting, with particular interest in the orthopaedic aspect of podiatric management. Melissa has a research interest in podiatry-led interventions for the orthopaedic patient population. She also runs her own private podiatry practice in Adelaide and is a mother to four young girls.