I saw a 62-year-old male patient this morning who came looking for a steroid injection for his foot.
He had pain on and off for 2 years and recently paid privately to see an orthopaedic consultant.
An x-ray and MRI of the foot revealed nothing unordinary other than mild degeneration and the consultant recommended a steroid injection.
On examination the patient reported that the pain was along the outside and top of the foot. As I took the case history, I suspected that he would not require a steroid injection.
Normally, when I need to do a steroid injection to a foot, it’s for a specific location, perhaps a toe, ankle joint or a tendon but in this instance the pain was dispersed.
On examination, his mid foot (cuneiform bones) was restricted in their movement and if the patient tried to come up on his toes, he was unable to due to the pain. Once I mobilised the ankle and mid foot, he was able to elevate onto his toes and he was able to walk easier.
The reason for this blog is to try and educate people that most musculoskeletal pains should be assessed by a qualified manual therapist as nine times out of ten they will be able to resolve the issue and if not, then will look to refer you on.
This is what I mean by ‘putting the cart before the horse’. Orthopaedic consultants specialise in surgical and injection procedures. They will look at imaging and diagnose from what is shown. To be honest, anyone over the age of 25 years will start to develop degenerative change but if the function/movement of the joint can be improved then usually the pain will subside but the so-called degenerative changes will still be there.
Consultants usually do not notice the subtle movement restrictions and imaging certainly will not. It is up to the manual therapist to assess the joints and tissues and deduct if the function is compromised.
This patient would have to have paid to see the consultant privately at a cost of around £250 plus the cost of the X-ray (£60) and MRI (£400). So, a total cost of around £700 when my fee was £70. This patient had a treatment with one more session booked in and he should be fine after that.