Swipe om te navigeren naar een ander artikel
Foot and ankle pain is common in the Australian adult population. People with musculoskeletal foot and ankle conditions are often referred for surgical opinion, yet how patients are managed prior to referral is largely unknown. The aim of this study was to determine the characteristics and management of patients with musculoskeletal foot and ankle complaints prior to public-sector orthopaedic referral in South Australia.
People with non-urgent foot or ankle complaints were recruited over a 12-month period from the waiting-lists of three tertiary hospitals in Adelaide, Australia. Participants completed a questionnaire on their medical history, duration and location of their foot or ankle complaint, diagnosis of their condition, previous treatment and medical imaging. The Manchester-Oxford Foot and Ankle Questionnaire, and the EuroQol-5D-5 L 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.
Two hundred and thirty-three adults returned questionnaires, with a survey response rate of 38.4% (66.1% female, median age 57.7 years IQR 18.5, BMI 29.3 kg/m2 IQR 8.7). Half of the participants had seen a podiatrist (52.8%), and 36.5% did not see any other health professional prior to orthopaedic referral. Sixty-five (27.9%) had not yet been given a diagnosis. 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).
More than one-third of the participants had not accessed allied-health care prior to specialist orthopaedic referral. Participants may consider their GPs opinion on the necessity of surgery compelling, and most expected to undergo surgery, but many couldn’t report their diagnosis. 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.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2197–223. CrossRef
Thomas MJ, Roddy E, Zhang W, Menz HB, Hannan MT, Peat GM. The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain. 2011;152:2870–80. CrossRef
Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study: the north West Adelaide health study. J Foot Ankle Res. 2007;1:2. CrossRef
Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW; 2016.
Menz HB, Jordan KP, Roddy E, Croft PR. Characteristics of primary care consultations for musculoskeletal foot and ankle problems in the UK. Rheumatology (Oxford). 2010;49:1391–8. CrossRef
Bishop C, Thewlis D, Hillier S. Custom foot orthoses improve first-step pain in individuals with unilateral plantar fasciopathy: a pragmatic randomised controlled trial. BMC Musculoskelet Disord. 2018;19:222. CrossRef
Menz HB, Auhl M, Tan JM, Levinger P, Roddy E, Munteanu SE. Effectiveness of foot orthoses versus rocker-sole footwear for first metatarsophalangeal joint osteoarthritis: randomized trial. Arthritis Care Res (Hoboken). 2016;68:581–9. CrossRef
McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB. Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial. BMJ. 2012;344:e3260-0.
DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am 2003;85-A:1270–1277.
Struijs PA, Kerkhoffs GM. Ankle sprain: the effects of non-steroidal anti-inflammatory drugs. BMJ Clin Evid. 2015;2015:1115.
Homeming LJ, Kuipers P, Nihal A. Orthopaedic podiatry triage: process outcomes of a skill mix initiative. Aust Health Rev. 2012;36:457–60. CrossRef
Walsh TP, Pilkington DC, Wong EJ, Brown CH, Mercer GE. Orthopaedic triaging by podiatrists: a prospective study of patient satisfaction and service efficiency. Aust Health Rev. 2014;38:406–11. CrossRef
Bonanno DR, Medica VG, Tan DS, Spring AA, Bird AR, Gazarek J. Evaluating the outcomes of a podiatry-led assessment service in a public hospital orthopaedic unit. J Foot Ankle Res. 2014;7:45. CrossRef
Walsh TP, Ferris LR, Cullen NC, Brown CH, Loughry CJ, McCaffrey NM. The integration of a podiatrist into an orthopaedic department: a cost-consequences analysis. J Foot Ankle Res. 2017;10:44. CrossRef
Paterson KL, Harrison C, Britt H, Hinman RS, Bennell KL. Management of foot/ankle osteoarthritis by Australian general practitioners: an analysis of national patient-encounter records. Osteoarthr Cartil. 2018;26:888–94. CrossRef
Layne EI, Roffey DM, Coyle MJ, Phan P, Kingwell SP, Wai EK. Activities performed and treatments conducted before consultation with a spine surgeon: are patients and clinicians following evidence-based clinical practice guidelines? Spine J. 2018;18:614–9. CrossRef
Freed GL, Turbitt E, Allen A. Public or private care: where do specialists spend their time? Aust Health Rev. 2017;41:541–5. CrossRef
Chatterton BD, Muller S, Thomas MJ, Menz HB, Rome K, Roddy E. Inter and intra-rater repeatability of the scoring of foot pain drawings. J Foot Ankle Res. 2013;6:44. CrossRef
Dawson J, Boller I, Doll H, Lavis G, Sharp R, Cooke P, et al. Minimally important change was estimated for the Manchester-Oxford foot questionnaire after foot/ankle surgery. J Clin Epidemiol. 2014;67:697–705. CrossRef
Morley D, Jenkinson C, Doll H, Lavis G, Sharp R, Cooke P, et al. The Manchester-Oxford foot questionnaire (MOXFQ): development and validation of a summary index score. Bone Joint Res. 2013;2:66–9. CrossRef
Maher AJ, Kilmartin TE. An analysis of Euroqol EQ-5D and Manchester Oxford foot questionnaire scores six months following podiatric surgery. J Foot Ankle Res. 2012;5:17. CrossRef
Dawson J, Boller I, Doll H, Lavis G, Sharp R, Cooke P, et al. Responsiveness of the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery. J Bone Joint Surg Br. 2012;94:215–21. CrossRef
Dorner TE, Muckenhuber J, Stronegger WJ, Ràsky É, Gustorff B, Freidl W. The impact of socio-economic status on pain and the perception of disability due to pain. Eur J Pain. 2011;15:103–9. CrossRef
Australian Bureau of Statistics 2016. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA) Australia cat. no. 2033.0.55.001, ABS, Canberra.
Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: John Wiley & Sons; 2000. CrossRef
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–9. CrossRef
Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Allyn & Bacon/Pearson Education; 2007.
Cameron AJ, Magliano DJ, Dunstan DW, Zimmet PZ, Hesketh K, Peeters A, Shaw JE. A bi-directional relationship between obesity and health-related quality of life: evidence from the longitudinal AusDiab study. Int J Obes. 2012;36:295–303. CrossRef
Taylor AW, Grande ED, Gill TK, Chittleborough CR, Wilson DH, Adams RJ, et al. How valid are self-reported height and weight? A comparison between CATI self-report and clinic measurements using a large cohort study. Aust N Z J Public Health. 2006;30:238–46. CrossRef
Butterworth PA, Landorf KB, Smith SE, Menz HB. The association between body mass index and musculoskeletal foot disorders: a systematic review. Obes Rev. 2012;13:630–42. CrossRef
Walsh TP, Gill TK, Evans AM, Yaxley A, Shanahan EM, Hill CL. Association of fat Mass and Adipokines with Foot Pain in a community cohort. Arthritis Care Res (Hoboken). 2016;68:526–33. CrossRef
Walsh TP, Arnold JB, Gill TK, Evans AM, Yaxley A, Hill CL, et al. Foot pain severity is associated with the ratio of visceral to subcutaneous fat mass, fat-mass index and depression in women. Rheumatol Int. 2017;37:1175–82. CrossRef
Tashani OA, Astita R, Sharp D, Johnson MI. Body mass index and distribution of body fat can influence sensory detection and pain sensitivity. Eur J Pain. 2017;21:1186–96. CrossRef
Tyrrell J, Mulugeta A, Wood AR, Zhou A, Beaumont RN, Tuke MA, et al. Using genetics to understand the causal influence of higher BMI on depression. Int J Epidemiol. 2018; Epub ahead of print.
Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011;12:964–73. CrossRef
Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;8:399–408. CrossRef
Berryman C, Stanton TR, Bowering KJ, Tabor A, McFarlane A, Moseley GL. Do people with chronic pain have impaired executive function? A meta-analytical review. Clin Psychol Rev. 2014;34:563–79. CrossRef
- Management of musculoskeletal foot and ankle conditions prior to public-sector orthopaedic referral in South Australia
Tom P. Walsh
Linda R. Ferris
Nancy C. Cullen
Jared L. Bourke
Melissa J. Cooney
Chi K. Gooi
Christopher H. Brown
John B. Arnold
- BioMed Central