Rotherham Foot/Ankle Pathway
Secondary Care
Patient presents with foot/ankle symptoms
Confirm diagnosis (see attached notes)
Please refer the
following directly
to Secondary
Care
History of or suspected
malignance, investigate
and refer as appropriate.
Consider red flags of
unexplained weight loss,
night pain and high
inflammatory markers.
Suspected fracture,
dislocation, or infection
refer to A&E.
Suspected inflammatory
condition, investigate
and refer to
Rheumatology.
Achilles tendon rupture
Do the calf squeeze test,
feel for palpable tendon
gap, (assess if can calf
raise if unsure). If tests
positive: refer directly to
A&E.
Primary Care
Midfoot
Hindfoot
1. Joint OA
Investigations -Weight bearing X-ray AP &
Lateral Ankle. MRI NOT indicated.
Treatment - ROM exercises,
strengthening, supportive footwear.
Injection therapy not indicated
Referral - If no improvement after 6 weeks of
conservative management refer to MSK Service.
Consider medical optimisation
2. Tendons / Ligaments
Investigations – None indicated
Treatment – ROM exercises,
strengthening, supportive footwear. If
tendinopathy advise on lifestyle/wt loss.
If plantar fasciitis consider 1x steroid injection
Referral - If no improvement after 6 weeks of
conservative management refer to MSK Service
3. Soft tissue mass (See red flags)
Investigations – None indicated
Treatment - If benign / painless – observe &
reassure. Consider aspiration if appropriate
Referral - If no improvement in 6 weeks refer to
MSK Service
Self Help/Patient information
1.
Heel pain leaflet
Self Help/Patient information
Tendinopathy
Flexible foot – (Passively
correctable flat foot)
Investigations – Weight bearing X-ray
AP & Lateral
Treatment - If painless, observe &
reassure
AdvIse on footwear and padding.
Referral - If no improvement after 6
weeks of conservative management:
refer to MSK
2.
Rigid midfoot deformity – (not
correctable, OA)
Investigations – Weight bearing X-ray
AP, Oblique & Lateral Ankle
Treatment - ROM exercises,
strengthening, supportive footwear. If
tendinopathy advise on lifestyle/wt
loss.
If Plantar fasciitis consider 1x steroid
injection
Referral - If no improvement in 6
weeks refer to MSK
www.cks.nhs.uk
TA rupture diagnosis
Forefoot
1. Big toe deformities (Hallux Valgus / Rigidus)
Investigations – Weight bearing X-ray AP & Lateral
Treatment – Advise on footwear and padding
Referral - If no improvement after 6 weeks of conservative
management: refer to MSK.
If patient wishes to consider surgery consider medical
optimisation
2. Lesser toe deformities / Metatarsalgia
Investigations – None indicated
Treatment – Advise on footwear, padding and strapping of
digit
Referral - If no improvement after 6 weeks of conservative
management: refer to MSK. If patient wishes to consider
surgery consider medical optimisation
3. Morton’s Neuroma / Soft Tissue mass
Investigations – For neuroma: Ultrasound scan
Treatment – If benign / painless – observe & reassure.
Consider aspiration if appropriate. Advise on footwear and
padding
Referral - If no improvement after 6 weeks of conservative
management: refer to MSK
Self Help/Patient information
Bunion leaflet
Mortons Neuroma leaflet
Mortons Neuroma -management