- Ultrasound scan for Morton’s neuroma
- 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.
Please follow links in the right panel for the Rugby Foot and Ankle Pathway and Referral Guidelines.