COVID-19 Adjusted Treatment Pathways
Community Physiotherapy are accepting referrals for steroid injection but only injecting those that are low risk (see exclusions below).
The service is also still accepting non-invasive referrals for musculoskeletal conditions.
Exclusions for steroid injection :
> 70 yrs old
Diabetics and patients with underlying heart and chest conditions.
Steroid injections are not currently being performed at UHCW in Musculo-Skeletal / Orthopaedics / Radiology. Please do not currently refer to UHCW for this purpose.
- Ultrasound scan for Morton’s neuroma
- Although a plain X-ray may show a calcaneal spur this is unlikely to affect the management – therefore unhelpful and request is likely to be refused. Ultrasound and MR can demonstrate plantar fasciitis, but again, are unlikely to help manage the problem.
Osteoarthritis First MTP Joint & Hallux Valgus
GP Gateway has a separate page about commissioning policy for Bunion, click the A-Z tab and go to B for Bunion.
- Uric acid blood test
- Standing X-ray AP and Lateral – hallux rigidus, hallux valgus
- Pre-rheumatology referral -blood tests and standing x-ray of the affected joint.
Tenosynovitis of Foot & Miscellaneous Foot Pain
- Uric acid blood test.
- Consider stress fracture and X-ray if suspicious. Bear in mind that stress fractures can be negative on the initial X-ray, so MR is the investigation of choice if the plain film is normal and pain persists.
- For tenosynovitis or Achilles tendon injury, ultra-sound may be helpful.
Referral to CMS (MSK)
- Please see the page on physiotherapy service
Referral to Podiatry
- Please see the page on Podiatry
Referral to Secondary Care
Refer to secondary care if any of the following are present:
- Patients currently under the care of a consultant for the same condition
- Patient is amenable to surgical intervention where applicable
- Stress Fracture
- Malignant bone tumour
- Avascular necrosis
- Septic arthritis
- Acute tendon rupture
- Acute infection
- Bunion (requirements under Low Priority Procedure policy: failure of conservative management; severe deformity or severe pain causing severe functional impairment)
Please see right for information on specific foot and ankle conditions.