From Consultation to Treatment: A One-Stop Approach to Musculoskeletal Injury

When you’re dealing with a foot, ankle or lower-limb injury, one of the most frustrating parts of seeking treatment can be the waiting.

An initial appointment leads to a scan. The scan leads to another appointment. Then comes a discussion about treatment, followed by another wait before treatment actually begins.

For many of the patients I see, particularly those funding their own treatment, I aim to make that process considerably more efficient.

My approach to musculoskeletal assessment is designed, where clinically appropriate, to bring consultation, diagnostic imaging, treatment planning and the start of treatment together into a single appointment.

Step 1: Understanding the problem

Every appointment starts with a detailed clinical consultation.

Before deciding whether imaging or treatment is required, I want to understand the problem properly: when it started, what aggravates it, how it affects your sport, work or everyday activities, and what treatments you may already have tried.

This is followed by a physical examination tailored to the injury. Depending on the problem, this may include assessment of joint movement, muscle and tendon function, strength, stability, gait and specific clinical tests.

The aim isn't simply to identify where it hurts, but to understand why it hurts and what structure may be responsible.

Step 2: Diagnostic ultrasound – when appropriate

For many musculoskeletal conditions affecting the foot and ankle, diagnostic ultrasound can provide useful information immediately within the consultation.

Rather than referring a patient elsewhere for an ultrasound and arranging another appointment to discuss the findings, I can perform the scan myself as part of the assessment where indicated.

Ultrasound can be particularly useful when assessing conditions involving structures such as:

• The plantar fascia

• Achilles and other tendons

• Morton's neuroma

• Bursae

• Ligaments

• Joint effusions and synovitis

• Some soft-tissue lumps and swellings

Importantly, not every patient needs an ultrasound.

Imaging should answer a clinical question rather than simply being performed because it is available. There are also situations where X-ray, MRI or another form of investigation will provide more appropriate information, in which case this can be discussed and arranged.

Step 3: Putting the examination and scan together

One of the biggest advantages of performing the clinical assessment and ultrasound within the same consultation is that the two can be interpreted together.

A scan finding in isolation doesn't necessarily explain a patient's symptoms.

By combining the history, clinical examination and imaging findings, we can build a clearer picture of the likely diagnosis and, importantly, discuss what those findings actually mean for you.

I can show patients relevant findings on the ultrasound screen and explain how they relate to their symptoms.

This means you leave the consultation with a much better understanding of what the problem is, what we've found and what we can do about it.

Step 4: Building the treatment plan

Once we have established a working diagnosis, we can discuss the available treatment options.

There is rarely a single treatment that is appropriate for every patient.

The plan might involve activity modification and rehabilitation, footwear advice, orthoses, medication where appropriate, shockwave therapy, injection therapy or other interventions. Occasionally, the most appropriate next step is further imaging or referral to another specialist.

The treatment plan is therefore based not only on the diagnosis but also on your goals.

The priorities of an athlete trying to return to competition may be very different from someone whose primary aim is to walk comfortably or get through their working day without pain.

Step 5: Starting treatment

For self-funding patients, treatment can often begin during that same appointment if it is clinically appropriate and the patient wishes to proceed.

That is where the one-stop approach can make a significant difference.

Instead of:

Consultation → wait → scan → wait → results appointment &

treatment planning → wait → treatment

the journey can often become:

Consultation, examination, diagnostic ultrasound, diagnosis, treatment plan and begin treatment

All within one visit.

This doesn't mean rushing treatment. In some cases, taking time, obtaining additional imaging or considering the available options is absolutely the right thing to do.

The objective is simply to remove unnecessary delays when there is no clinical reason for them.

What about patients using private medical insurance?

I also see patients funded through private medical insurance, and much of the same pathway can still apply.

However, insurers have different rules regarding investigations and procedures.

Depending on your policy and insurer, additional authorisation may be required before certain scans, injections, orthoses or other treatments can be performed.

This means that while we may be able to complete the consultation, examination and formulate a treatment plan at the initial appointment, occasionally treatment has to wait until the insurer has provided the necessary authorisation.

If you are using insurance, obtaining as much information as possible about your authorisation and policy before attending can therefore help make the process more efficient.

A more efficient approach to MSK care

My aim is not to perform as many investigations or treatments as possible in one appointment.

It is to make the right clinical decisions as efficiently as possible.

Having clinical assessment, diagnostic ultrasound and a range of treatment options available within the same service means that, for many patients, we can significantly shorten the journey from:

“I've got an injury and I don't know what's wrong”

to:

“I understand the diagnosis, I know what the plan is, and I've started doing something about it.”

For someone dealing with an injury that is stopping them running, training, competing, working or simply doing the things they enjoy, reducing that uncertainty and unnecessary waiting can be extremely valuable.

Book Now

Mr L Stapleton MSc PGdip PGc FFPM RCPS(Glas) FRCPodM

Consulting Podiatrist Prescriber and Specialist in Podiatric Sports Medicine