NHS AYRSHIRE AND ARRAN
MUSCULOSKELETAL FOOT AND ANKLE PATHWAY
For further information please contact:
Judith Reid, Consultant Physiotherapist in MSK,
Crosshouse Hospital.
Email; judith.reid.aapct.scot.nhs.uk
STAGE ONE
Initial presentation of foot and ankle disorders
Red Flags for possible foot and ankle pathology. A patient presenting with
any of the following red flag signs or symptoms requires urgent referral
Unexplained swelling,
redness, pain; signs and
symptoms of infection
Systemically unwell
Urgent referral to GP or
A&E
Orthopaedics
Unable to weight-bear
Signs and symptoms of
fracture or tendon rupture
Urgent referral to A & E/
Orthopaedics
Sudden acute leg pain
Urgent referral to A & E
Multiple joint pains
Symptoms of Charcot foot
Urgent referral to
indicated speciality
Diabetes/ Rheumatology
STAGE TWO
GP Management
In absence of need for immediate referral
 Rule out infection, trauma
 Explain and reassure
 Return to normal activity or temporarily modify work as
soon as possible within the limit of the disability and pain
 Control symptoms
 Enable self-help / management
 Screen for Diabetes/ Inflammatory markers
 If symptoms of plantar fasciitis direct to self help and
ensure supportive footwear worn eg. trainers
 Use of ice, rest and over the counter arch support
National Rheumatiod Arthritis Society (NRAS)
 Do they have the S Factor?
 Stiffness – Early morning joint stiffness >30min
 Swelling – persistent swelling of one joint or more, especially hand
joints
 Squeezing – squeezing the joints is painful in inflammatory arthritis
 http://nras.org.uk/about rheumatoid arthritis/nras dvd for early
diagnosis .aspx
 Consider a referral to Rheumatology
Drug Therapy
Analgesics  Paracetemol
 NSAIDS
 Weak Opiods
Self Help / Information Resources
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Provide information / Patient Advice Leaflets
www.arthritiscare.org.uk
www.nhs.uk
www.patient.co.uk
www.nhsinform.co.uk
STAGE THREE
REFERRAL
RECHECK FOR RED FLAGS
IMMEDIATE OR URGENT
ORTHOPAEDIC / A & E
REFERRAL
In
IN ABSENCE OF RED FLAGS
CONSIDER ORTHOPAEDIC REFERRAL IF



Severe / advanced OA
Severe / advanced deformity
Patient unwilling to change footwear to accommodate orthotic
CONSIDER REFERRAL TO MSK SERVICE IF
 Hallux Rigidus
 Hallux Valgus
 Morton’s Neuroma
 Ligament sprains
 Tendinopathies (Achilles,Peroneal,Tibialis Posterior)
 Osteochondrosis
 Posterior heel pain
 Toe deformities
 Pronated foot
 Supinated foot
 Metatarsalgia
 Paediatric flat foot
 Plantar Fasciitis
 Neurological deformity
 Early stage OA
CONSIDER WORKING HEALTH SERVICE (Appendix 2)
www.healthyworkinglives.com
www.salus.co.uk
Self refer: 0800 019 2211
C
PROCESS FOR REFERRALS TO MSK SERVICE
Electronic referral via SCI gateway with additional triage information to
‘MSK triage’
Please note: Referrals directed to Orthopaedics considered to be more
suitable for MSK will be redirected
STAGE FOUR
AHP MSK SERVICE
FOOT and ANKLE
Communication with
GP, referral returned or
redirected appropriately
Re-evaluate for worrying
pathology, disorder not suitable
for MSK service
Mild signs and
symptoms
Consider
provision info
with opt in. Self
management/
Discharged
Moderate signs and
symptoms
Routine MSK
service
Podiatrist
/Physio/
Orthotics
Severe signs and
symptoms
Advanced
Practitioner/
Combined Clinic
(Injection, imaging)
Orthopaedics
If failing to progress after
4 sessions - senior
clinician support
Other acute services
Pain services
Discharged