Telemedicine Foot and Ankle Visits in the COVID-19 Era

Abstract

Background: The COVID-19 pandemic created a difficult environment to provide musculoskeletal care to patients with foot and ankle pathology given the limitations placed on in-office visits. Telemedicine offered a unique avenue to reach these patients; however, the efficacy of telemedicine visits in patients with foot and ankle pathology is not well studied. We propose a telemedicine protocol that has allowed us to effectively see and treat patients with foot and ankle pathology. Methods: A 12-step standardized telemedicine protocol was created within the Foot and Ankle division that was used for seeing patients through telemedicine. Also included in this is previsit preparation and follow-up recommendations. Press Ganey surveys were retrospectively reviewed to understand patient experience with telemedicine. Results: 85.2% of patients surveyed responded with scores indicating excellent care. When comparing patients who were seen in-office and through telemedicine, 89.2% and 83.4% responded with scores indicating excellent care, respectively ( P = .37). Conclusion: Telemedicine offers an effective and convenient way to provide excellent musculoskeletal care to patients affected with foot and ankle pathology. This is the first study that evaluated a comprehensive protocol for telemedicine encounters and can be used to implement telemedicine by others using this approach. Level of Evidence: Level V, expert opinion.

A scoping review of foot and ankle telemedicine guidelines

“…There were six eligible articles relating in whole or part to the foot and ankle. 21 , 22 , 23 , 24 , 25 , 26 However, the foot and ankle have been discussed from various professional viewpoints. For example, the only study that mentioned telemedicine in podiatry related to rheumatoid and musculoskeletal disease 24 ; another three articles focused on the foot and ankle from an orthopedic standpoint.…”

“… 21 , 23 , 26 In contrast, two studies kept their virtual foot and ankle examinations open, referring to medical practitioners providing a virtual musculoskeletal examination. 22 , 25 Also, in the UK, 27 Australia, 28 and New Zealand, 29 three different but overlapping sets of guidelines for telemedicine in podiatry were set up in 2020.…”

“…Six research articles provided the primary functions of telemedicine. These were clinical decision‐making, 26 treatment, and follow‐up 21 , 22 , 23 , 25 or only follow‐up, 24 which are categorized below (Figure 3 ).…”

“…All of the six identified research articles utilized synchronous communication. 21 , 22 , 23 , 24 , 25 , 26 Various configurations, including video conferencing, 21 , 22 , 23 telephone calls, 24 , 26 or both, 25 as depicted in the chart above, were used to achieve a telemedicine consultation (Figure 4 ). As for the recommended guidelines by public entities, they also referred to synchronous communication; but, they referred to telehealth only through video conferencing.…”

“…Four articles examined specific outcomes, which included patient satisfaction 23 , 25 , 26 ; comfort, and time burden 23 ; cost‐effectiveness 24 ; and treatment outcomes. 24 , 26 Specifically, treatment outcomes were centered on the number of contact attempts required to reach a patient, call duration, and the number of completed calls per working day.…”