To investigate the outcomes following 3 weekly sessions of radial extracorporeal shockwave therapy (rESWT) in patients with chronic greater trochanteric pain syndrome (GTPS) presenting to an NHS Sports Medicine Clinic in the United Kingdom. Design: Double-blinded randomized controlled trial. Setting: A single NHS Sports Medicine Clinic, in the United Kingdom. Patients: One hundred twenty patients in an NHS Sports Medicine clinic presenting with symptoms of GTPS who had failed to improve with a minimum of 3 months of rehabilitation were enrolled in the study and randomized equally to the intervention and treatment groups. Mean age was 60.6 6 11.5 years; 82% were female, and the mean duration of symptoms was 45.4 6 33.4 months (range, 6 months to 30 years). Interventions: Participants were randomized to receive either 3 sessions of ESWT at either the "recommended"/"maximally comfortably tolerated" dose or at "minimal dose." All patients received a structured home exercise program involving flexibility, strength, and balance exercises. Main Outcome Measures: Follow-up was at 6 weeks, 3 months, and 6 months. Outcome measures included local hip pain, validated hip PROMs (Oxford hip score, non-arthritic hip score, Victorian Institute of Sport assessment questionnaire), and wider measures of function including sleep (Pittsburgh sleep quality index) and mood (hospital anxiety and depression scale). Results: Results were available for 98% of patients at the 6-month period. There were statistically significant within-group improvements in pain, local function, and sleep seen in both groups. However, fewer benefits were seen in other outcome measures, including activity or mood. Conclusion: There were no time 3 group interaction effects seen between the groups at any time point, indicating that in the 3 sessions, the "recommended-dose" rESWT had no measurable benefit compared with "minimal dose" rESWT in this group of patients with GTPS. The underlying reason remains unclear; it may be that rESWT is ineffective in the treatment of patients with chronic GTPS, that "minimal dose" rESWT is sufficient for a therapeutic effect, or that a greater number of treatment sessions are required for maximal benefit. These issues need to be considered in further research.

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Objective: There has recently been a paradigm shift in the management of Achilles tendon rupture and ankle fracture rehabilitation with emphasis on early mobilisation. There is, however, no consensus on post-operative rehabilitation for hind/mid-foot fusion and reconstructive surgery. The aim was to scope the post-operative rehabilitation practices of UK foot and ankle surgeons and allied health professionals (AHPs). Methods: A 10 question online survey was sent to UK surgeons and AHPs via specialist interest groups in February 2019. Quantitative and qualitative data were analysed. Results: 117 surgeons and 55 AHPs responded. There was good agreement between survey responses in the 2 groups. Fifty percent reported that they followed a local post-operative rehabilitation protocol. More than half of respondents (57%) reported that not all patients were referred for post-operative rehabilitation. There was a wide variation in the time point at which patients were instructed to weight bear (2 weeks to >12-weeks). Non-union was a concern of early mobilisation as highlighted by 62% of respondents. Qualitative themes identified were: treatment tailored to individual patients, lack of knowledge about the patient journey, treatment tailored to surgeon preferences, lack of a pathway, variation in practice. Conclusions: There is a wide variation in the post-op rehabilitation of patients undergoing this surgery in the UK, with a lack of published research in this area. Early rehabilitation could improve patient outcomes, yet the risk of non-union is a major concern. Further research in the form of a multicentre trial is warranted to answer this research question.

Category: Ankle; Hindfoot; Midfoot/Forefoot; Sports Introduction/Purpose: Ankle, hind and midfoot fusion/ reconstructive surgery is performed to treat a range of foot and ankle conditions. A prolonged period of immobilisation in plaster is usually advised following this type of surgery. More recently, there has been a paradigm shift in the management of Achilles tendon rupture/ ankle fracture rehabilitation with emphasis on early mobilisation. However there is little in the literature or guidelines on the post-operative rehabilitation for foot/ ankle reconstructive surgery, in particular, with regards to the period of immobilisation. The aim of this work was to scope the current practice of UK (United Kingdom) foot and ankle surgeons, and allied health professionals (AHPs) managing this patient group. Methods: An online survey (10 questions) was designed (using survey monkey) following a qualitative synthesis of published literature and sent to surgeons via BOFAS (British Orthopaedic Foot & Ankle Society) and AHPs via AFAP (Association of Foot & Ankle Physiotherapist & AHPs). Participants had 1 month to respond and reminder emails were sent out periodically by BOFAS/ AFAP. Results were collated via the online system and data were extracted in the form of tables and graphs. Raw data was also available to transfer to Excel for analysis. Free text responses were analysed using thematic analysis [10]. Data was coded manually to produce qualitative themes by 2 authors. Results: 117 surgeons and 55 AHPs responded and there was good agreement between the 2 groups. Almost 50% reported that they followed a local post-operative rehabilitation protocol. There was a wide variation in the time point when patients were instructed to weight-bear (2 weeks to >12-weeks). 57% reported that not all patients were routinely referred for post-operative rehabilitation. Non-union was a concern of early mobilisation as highlighted by 60% of the surgeons surveyed yet more than half (59%) believed that starting some weight-bearing at 2-weeks would reduce the risk of venous thromboembolism. Qualitative themes identified: treatment tailored to individual patients, lack of knowledge about the patient journey, treatment tailored to surgeon preferences, lack of a pathway, variation in practice (quotes in table 1). Conclusion: There is wide variation in the post-op rehabilitation of patients undergoing hind mid-foot surgery in the UK, with a lack of published research/ guidance in this area. Early rehabilitation could improve patient outcomes, yet the risk of non-union is a major concern. In recent years, there has been a paradigm shift in the management of Achilles tendon rupture and ankle fracture with an emphasis on early mobilisation, This is a treatment model we propose to replicate in hind/ mid-foot fusion populations. Further research in the form of a multicentre trial is warranted to inform international guidance in this area. [Table: see text]