Management of musculoskeletal foot & ankle conditions prior to public-sector orthopaedic referral in SA

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 Cooney

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.

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