fbpx

GP triage – Ankle Menu

Common Ankle Problems

Ankle Sprain (Lateral)
Injured ankle during an activity
Pain on outside of ankle
Swollen Ankle
Difficult walking for first few days after injury
Advice & education
First aid (RICE)
Exercises / stretches
NSAIDs/Simple analgesics
Activity restriction
Refer physiotherapy
No investigations indicated unless fracture suspected
If symptoms persist more than 12/52 despite treatment
Achilles Tendonopathy
Pain over posterior heel/ lower limb
More painful after exercise/ activity
Feeling of stiffness first thing in morning or after period of inactivity
Stiffness improves with activity
Advice & Education
Analgesia
Physiotherapy
No investigations indicated unless fracture suspected
If symptoms persist > 12/52
Plantar Heel Pain
Plantar heel pain
Worse with load
Worse in the morning
Do not inject
Discuss weight loss
Advice
Exercise
Physiotherapy
Podiatry
NSAIDS
Simple analgesics
No investigations indicated in initial stages
If symptoms persist > 12/52
Patient requires personalised orthotics
Hallux Valgus (Bunions)
Big toe pointing towards the other toes
Swollen, bony bump on the outside edge of your foot
Big toe joint pain/ swelling that’s made worse by pressure from wearing shoes
Sore skin over the top of the bunion
Review if needed at 12 week
Advice & Education
Simple analgesics
Footwear
Over the counter orthotics
No investigations indicated
X-ray if diagnostic uncertainty
If Rheumatological component suspected – FBC; ESR; CRP
Uric Acid if systemic cause suspected
If symptoms persist more than 12/52
Impending or unhealed ulceration
Lower limb ischemia
Persistent pain
Unable to manage by altering footwear
Increasing deformity (especially with family history)
Pain elsewhere in foot due to altered foot mechanics
Affecting ability to work
Plantar Fibromatosis
Commonly present on the medial border of the sole
Pain with applying pressure on lump
Pain with wearing restrictive shoes
Pain with walking barefoot
Pain with standing fro long periods
No treatment indicated
No investigations indicated in initial stages
Ultrasound may help to differentiate the nature of the thickening
If symptomatic and thickening/ growing
Pes Planus (Flat Foot)
Plantar heel pain
Worse with load
Worse in the morning
Advice & Education
Wear trainers/ Supportive footwear
Over counter orthotics helpful for mild cases
Refer to Podiatry if not improving
No investigations indicated in initial stages
Inability to go onto tip-toes or very painful
Not improved with other measures
Metatarsalgia/ Neuroma/ Forefoot pain
Big toe pointing towards the other toes
Pain in ‘ball of the foot’ at the end of one or more of the metatarsal bones
Typically aggravated when walking or running
Sharp or shooting pain, numbness, or tingling in your toes
Common ‘feeling of having a pebble in shoe’
Do not inject
Discuss weight loss
Footwear Advice
Podiatry/ Physiotherapy referral
NSAIDS
Simple analgesics
No investigations indicated unless stress fracture suspected
If symptoms not improving after 12/52
Not managing with treatment
Painful Ankle
Pain and swelling over ankle joint
Stiffness first thing in morning or after inactivity
Stiffness improves with activity
Pain may increase with walking/ exercise
Symptom improvements with rest
Education and advice
Footwear
Weight loss
Podiatry/ Physiotherapy referral
Weight bearing X-ray (mortice & lateral views) if not improving after 6 weeks or if OA or fracture suspected
Not improving with treatment at 12 weeks
If signs of inflammatory process refer to rheumatology pathway