MSK toolkit
Theme 2: Treatment outcomes

Providing an evidence base to MSK podiatry treatment offers credibility, effectiveness and value to practice and the profession. Patient outcome measures (PROMS) are valuable as the main aim of any intervention is to get the patient better. In MSK podiatric practice presenting symptoms are mostly represented as pain from injury, reduced function or systemic disease; the podiatrist will work with the patient to reduce or manage the amount of pain experienced and help to maintain function and manage disease. Pain perception from the patient is often measured with a numerical visual analogue scale to record a value of 0-10 which represents how much pain the patient associates with their problem. More recently this measure has been accompanied with the MOXFQ (Manchester -Oxford Foot Questionnaire) which has been shown to be the most reliable and repeatable clinical tool of the available PROMS [7]. This measure evaluates the amount of pain, ability to walk or stand and has an assessment parameter linked to social interaction and quality of life.

PASCOM-10 the podiatry audit tool https://www.pascom-10.com/ allows for the practitioner to collate audit information about the pathology, treatment and PROMS from a contact with an MSK patient. Recently a modification to the original data collection proforma has been formulated to allow for faster and more relevant data set to be collected around MSK activity [Appendix 2 - MSK Short-Form demonstration]. Promoting utilisation of this tool will build on the supportive evidence available to promote efficacy of MSK podiatry intervention whilst boosting reliable outcomes to support further research.

From analysis of existing data, 208 complete inputs from 9 centres in PASCOM demonstrated that plantar heel pain is the most prevalent condition seen by MSK podiatry (Table 1) with a vast array of other pathologies being diagnosed and recorded. Overall, the percentage improvement after intervention was 19%. However, it is critical to observe that in the most prevalent foot conditions there was on average a 30- 25% improvement across all MOXFQ parameters and in others improvement in the MOXFQ measure rose above 30%. Equally, the observed incidence and improvement in PROMS were also observed in an audit of 86 contacts where plantar heel pain was diagnosed most frequently and the MOXFQ significantly improved with podiatry intervention [8] [Appendix 2- PASCOM paper]

Table 1Observed frequency of pathology. MOXFQ results, average % change in scores after review for each domain with an overall % average improvement. Totals indicate 210 incidences of care and overall % improvement for all pathologies.

Pathology

Frequency Observed  

MOXFQ overall

Pain   

Walk/
Stand

Social

Plantar Heel Pain

49

26.8

28.1

20.9

25.3

Pes Planus

36

33.9

33.7

23.4

30.3

PTTD

19

28.1

26

25.2

26.4

Rheumatoid foot

18

15.5

7.7

7

10.1

Midfoot OA

14

6.2

12.1

7.8

8.7

Hallux Rigidus

 

17.6

10

2.6

10.1

Peroneal Tendon

3

1.3

16.6

2

6.6

Lateral Foot

3

33

20

12.3

21.7

Fat Pad

2

39.5

15

44

32.8

Sesamoid

2

21.5

10

3

11.5

Ankle instability

2

12.5

10.1

1.1

8.1

TOTAL

208

21.6

20.5

15.7

19.2


Where OA= Osteoarthritis, PTTD= Posterior Tibial Tendon Dysfunction, HAV= Hallux adductor valgus, IM= Intermetatarsal

For the purpose of this report, it should be noted that the presented MSK data collected has been extracted from PASCOM in its purpose as an audit tool for Podiatric Surgery and not the new MSK short-form. This tool has been identified as a suitable audit tool for MSK data and hence has been modified and changes made to create the MSK short form. This MSK short-form in PASCOM purely focuses on the MSK podiatrist and allows for a larger range of podiatric diagnoses to be reported on [ICD-10 codes Appendix 2]. The design of the new form has been modified to allow for quick use by the podiatrist working solo with evaluation and modification from a pilot review with East Sussex Healthcare trust, as well as with expert users of the original PASCOM system (Hadlow, Serrano, Welsh). From this feedback, several amendments have been made to the form (Table 2) and the MSK short-form tool will be launched to all members in Autumn 2021 to encourage a wider group of MSK podiatrists to register and use it.

 Table 2Changes to the PASCOM forms based on focus groups, evaluation and feedback.

Identified Problem

Changes made

Difficult to fill in with too many processes

Amalgamation of all data required to complete the form into 2 episodes of care

1)      Assessment

2)      Review

Diagnoses are not relevant

Updated ICD-10 codes with a broader MSK focused set of pathologies to allow for representation of caseloads [Appendix 2]

MOXFQ is not patient friendly to use and is
time-consuming

Altered the format of MOXFQ form to allow users to email the form to patients prior to appointments. The format was also changed to include an electronic response so that the patient could email the form back to the podiatrist.

Treatments are not relevant

Survey conducted through MSK:UK to collate information about a broad spectrum of treatments utilised by the MSK podiatrist. This gives a comprehensive choice for reporting.


A wider pilot study to assess the usability of the MSK short-form has been conducted in Northern Ireland with the additional feature of reporting medical device regulations. This has given a further opportunity to gather data from the patients assessed using the form, particularly diagnosis of pathology and treatments used. Giving a vision of what future data on MSK incidence and outcomes would look like (Table 3). From 5 practices registered, 200 contacts were reported during May and June 2021. Table 3 highlights the type of data possible to extract from the MSK short-form including the pathologies diagnosed and the treatments provided.

Table 3 - Representative data available to extract from the MSK short-form, where WS= walking speed P=pain and SI= social interaction for MOXFQ (score out of 100, larger being more problematic)

Gender

Age

Podiatric Diagnosis

VAS

MOXFQ

Intervention

WS

P     

SI 

M

59

Posterior tibial Tendon Dysfunction

8

64

65

50

Orthoses

F

60

Foot Drop

3

10

30

25

Richie brace

F

12

Anterior Tibial Syndrome

5

50

50

43

Orthoses

M

52

Plantar Heel pain

4

75

45

50

Strength/
orthoses

M

11

Osgood Schlatter

5

46

20

18

Orthoses

F

68

Posterior tibial Tendon Dysfunction

8

71

50

68

Orthoses

M

13

Patella Femoral Pain

5

42

50

50

Orthoses


Data moving forward in the future will be from a wider group of patients with a greater MSK focus, giving a clearer picture as to the impact this service has on patient outcomes.

Notes:

7  Whittaker, G.A., Munteanu, S.E., Roddy, E. and Menz, H.B., 2020. Measures of foot pain, foot function, and general foot health. Arthritis Care & Research, 72, pp.294-320.
8  Serrano, P. Latham, A. Branthwaite H, Chadwick P  A pilot study evaluating the use of PASCOM to audit MSK podiatry outcomes The podiatrist 43-45 Nov/Dec 2020

SHARE