Management of musculoskeletal foot and ankle conditions prior to public-sector orthopaedic referral in South Australia

Dr Tom Walsh1,2, Dr Linda Ferris2, Dr Nancy Cullen2, Mr Jared Bourke2, Ms Melissa Cooney2, Dr Chi Gooi2, Dr Christopher Brown3, Dr John Arnold4

1Queensland University Of Technology, Kelvin Grove, Australia, 2The Queen Elizabeth Hospital, Woodville South, Australia, 3Noarlunga Hospital, Noarlunga Centre, Australia, 4University of South Australia, Adelaide, Australia

Background: Frequent foot/ankle pain is common in the Australian adult population. People with musculoskeletal foot/ankle conditions are often referred for surgical opinion, yet management prior to referral is largely unknown. This study aimed to determine the characteristics and management of patients with musculoskeletal foot/ankle complaints prior to public-sector orthopaedic referral in South Australia.

Methods: 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 were asked to report 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: Two hundred and thirty-three adults returned questionnaires, with a survey response rate of 38.4% (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%), and 36.5% did not see any other health professional prior to orthopaedic 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).

Discussion: More than one-third of participants had not accessed allied-health care prior to specialist orthopaedic referral in this study. 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.


Dr Tom Walsh is a Podiatrist with over 10 years’ experience working in the public and private sectors, he is currently an Associate Lecturer at Queensland University of Technology. Dr Walsh completed his PhD on the mechanical and non-mechanical aspects of foot pain with obesity and has a long history of collaborative work and research with orthopaedics. He has broad research interests, but is particularly interested in projects that are collaborative and interdisciplinary.

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