MSK toolkit
Theme 5: Treatment protocols

A vast array of conditions are observed in adult MSK podiatry with a variety of frequencies in presentation (Table 1). Plantar heel pain presents with the highest incidence, followed by a mixture of tibalis posterior dysfunction, pes planus and osteo arthritis.  [Presenting Complaints, Appendix 3, PASCOM paper, Appendix 2.] A recent review of treatments that are most effective in managing these conditions has been completed to create evidence-based treatment protocols. These protocols guide practitioners to the most relevant and suitable treatments for the frequently diagnosed conditions. The protocols developed include [10]:

  • Heel/Plantar fascial pain
  • Achilles tendinopathy (insertional and mid portion)
  • Neuroma
  • Patella tendon dysfunction
  • Posterior tibial tendon dysfunction

The pathways developed guide the user on diagnosis, assessment, intervention and prognosis. They have been developed with research-based information and can be utilised at different levels of practice. Additional to the developed guidance there are also intervention guides on:

  • MSK guidance on steroid injections [11]

As research continues to develop around a deeper understanding of pathology and effectiveness of interventions, these pathways will need to be updated and kept current. Similarly, there are several conditions that are treated in MSK podiatry that have not got a developed care pathway. Table 1 represents conditions that are commonly diagnosed and treated, it is acknowledged that there is a paucity of research work to support strong diagnostic and intervention evidence to create set pathways of care for all pathologies encountered. The role of the advance podiatrist is to mentor and guide less experienced practitioners in management of less frequently observed conditions. Additionally, the application of underlying biomechanical principles allows an MSK podiatrist to provide appropriate intervention to a larger scope of mechanical and inflammatory conditions.

Notes:

10  Condition Pathways developed by Department of Foot Health, Ambulatory Therapies & Community Medicine, Sandwell and West Birmingham Hospital NHS Trust. Birmingham UK
11  Management of patients with musculoskeletal and rheumatic conditions guidance. June 2020 https://www.rheumatology.org.uk/Portals/0/Documents/COVID-19/MSK_rheumatology_corticosteroid_guidance.pdf 

 

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