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MSK audience - Simon Lack.jpg

Michael Stephenson

The MSK:UK sessions provided a well-balanced set of lectures from a wide range of contributors. The first was all about the knee, with Ian Griffiths chairing an interdisciplinary panel exploring the proximal, distal and gait considerations in managing patellofemoral pain (PFP). Dr Simon Lack started by outlining what PFP is and its prevalence, emphasising that when we start designing a treatment plan to be careful not to focus on the diagnosis but the fundamental deficits that lead to it. Dr Lack then looked at the assessment of hip control and the role of the proximal muscles in rehab. 

Alice Corbett then gave an overview of treatment from the distal aspect of the limb, using orthotics as an adjunct to a targeted exercise programme. Alice emphasised the importance of using treatment-directed tests such as navicular drop and drift and changes in midfoot width between the non-weight and weight-bearing foot as a test to evaluate how effective an orthotic intervention will be. The final presentation came from Brad Neal, who explored PFP in runners when establishing if gait retraining should be the focus. Brad emphasised that kinematic markers, which we know are associated with PFP such as hip abduction, contralateral pelvic drop and internal rotation, in isolation of other considerations, should be the key factors in the decision-making process. 

The main message from the session was that PFP is a common condition that we should expect to see as podiatrists and, as a result of the complex factors in its management, a team approach that assesses these factors and addresses them effectively is likely to lead to better outcomes.

Thursday evening saw Emma Cowley talking on extracorporeal shockwave therapy (ESWT) and about 40 attendees came along despite free wine downstairs! Emma gave an interactive talk discussing what we know about the modality to date, the difficulties with establishing therapeutic doses from the available evidence and how patient selection is key to success. Positive notes were identified in the application of ESWT in recalcitrant and difficult to treat conditions such as chronic tendinopathies, especially when used in combination with other therapies, and we ended on a discussion of emerging uses of ESWT in fracture and post-surgical care, vascular rehab and wound resolution.

The afternoon concurrent chaired by Richard Wilkins delivered a critical insight into the future of biomechanics. Professor Chris Nester built upon the themes from his keynote speech last year asking do we need to redefine the definition of foot biomechanics? And if so what needs changing? He also took the opportunity to promote the foot health priority setting partnership survey, a chance for patients, carers and health professionals to have their say on what the research agenda should look like going forward. If you haven’t yet contributed please go to www.foothealthpsp.org and fill out the survey and please also share with your patients. 

Dr John Arnold followed up outlining the prevalence of mid-foot osteoarthritis (OA) and exploring the clinical implications of assessment and treatment, highlighting OA is a disease of the whole joint ‘organ’ and the possible implication of muscle weakness in midfoot OA. The session was completed by PhD Student Zach Welshman discussing his work looking at foot modelling, characterising variations in ‘non-normal’ foot and ankle biomechanics using statistical shape modelling and a novel multi-body model.

On Saturday was the popular case study and practical workshop sessions. Hosted by Dao Tunprasert joined by Nick Night, Glen Foley and Emma Cowely the two sessions focused on practical examinations around knee pain and neuroanatomy. Both sessions attracted a broad range of practitioners, which created a collaborative atmosphere with questions and answers flowing back and forth.

Thanks again to MSK:UK for yet another fantastic array of chairs, speakers and subjects that I’m sure challenged those in attendance to reflect on their practice and clinical thinking.