It is common, that over time, the effectiveness of a treatment in the treatment management of a condition can change.

Care pathways exist so that patients and clinicians know when to proceed to the next treatment option or the next level of treatment strategy. Treatment pathways are usually based upon evidence. There is often research or experiential evidence to suggest the appropriateness of one particular treatment over another, however they can be fluid enough to allow them to be tailored individually and flexibly to a patient’s individual circumstances.

Sometimes, despite best efforts, some conditions may not respond to treatments as hoped, and a patient may move through a treatment pathway in order to successfully treat their condition.

In many treatment pathways surgical interventions are placed towards the end of a treatment pathway (lets rule out broken bones and other types of emergency surgery here), where other more conservative options have been explored and a patient begins to seek a more radical treatment option.

Examples of surgical treatments include minimally invasive procedures using the Koby system to treat two conditions that are frequently seen: Morton’s Neuroma and plantar fasciitis. Minimally invasive surgical options can be undertaken under local anesthetic as outpatient procedures in the office and can be used when traditional conservative treatments fail to provide satisfactory outcomes for a patient. A small incision is used to access either a small ligament near the Morton’s neuroma or the plantar fascia. With Morton’s neuroma the system is used to locate and precisely cut a small ligament to offer decompression to the neuroma, whilst with plantar fasciitis the plantar fascia is located and a partial fasciotomy can be performed.

Whilst surgical options may remain a more radical option, it is useful to have options available to patients when other treatments fail.