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Foot & Ankle Pain

  

Foot pain is a common problem with a wide range of possible causes.


COVID-19 Adjusted Treatment Pathways

Community Physiotherapy are now injecting all patients, both high and low risk with the only caveat is that we will leave 2 weeks prior or after vaccination to inject (June 2021)

Steroid injections are not currently being performed at UHCW in Musculo-Skeletal / Orthopaedics / Radiology. Please do not currently refer to UHCW for this purpose.

 

Updated Foot & Ankle Pathway November 2021

Important advice

Do not inject joints/soft tissues more than; once for plantar fasciitis and twice for all others

If injecting in a primary care setting, only inject under image (Xray/USG) guidance

If patient has skin condition or fungal nail infection- please consider referral to dermatology prior to referring to Podiatry

Please refer corns and callus secondary to severe deformity requiring surgery to secondary care for treatment

Please refer all in-growing toe nails to Podiatry, only refer to secondary care if requiring general anaesthetic for surgery.

Please include referral summary including all investigation results when referring to secondary care.

If you request for X-rays, please request for weight bearing X-rays for all non-traumatic foot & ankle problems

 

Forefoot Pain

 

Midfoot Pain

 

Heel Pain

 

Ankle / Hindfoot Pain

 

Morton’s neuroma
  • Ultrasound scan for Morton’s neuroma
Plantar Fasciitis
  • Although a plain X-ray may show a calcaneal spur this is unlikely to affect the management – therefore unhelpful and request is likely to be refused. Ultrasound and MR can demonstrate plantar fasciitis, but again, are unlikely to help manage the problem.
Osteoarthritis First MTP Joint & Hallux Valgus

GP Gateway has a separate page about commissioning policy for Bunion, click the A-Z tab and go to B for Bunion.

  • Uric acid blood test
  • Standing X-ray AP and Lateral – hallux rigidus, hallux valgus
  • Pre-rheumatology referral -blood tests and standing x-ray of the affected joint.
Tenosynovitis of Foot & Miscellaneous Foot Pain
  • Uric acid blood test.
  • Consider stress fracture and X-ray if suspicious. Bear in mind that stress fractures can be negative on the initial X-ray, so MR is the investigation of choice if the plain film is normal and pain persists.
  • For tenosynovitis or Achilles tendon injury, ultra-sound may be helpful.
Referral to CMS (MSK)
    Please see the page on physiotherapy service
Referral to Podiatry
    Please see the page on Podiatry
Referral to Secondary Care

Refer to secondary care if any of the following are present:

  • Patients currently under the care of a consultant for the same condition
  • Patient is amenable to surgical intervention where applicable
  • Stress Fracture
  • Malignant bone tumour
  • Avascular necrosis
  • Septic arthritis
  • Acute tendon rupture
  • Acute infection
  • Bunion (requirements under Low Priority Procedure policy: failure of conservative management; severe deformity or severe pain causing severe functional impairment)

Please see right for information on specific foot and ankle conditions.

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Rugby Guidance  

Please follow links in the right panel for the Rugby Foot and Ankle Pathway and Referral Guidelines.

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