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GP triage – Ankle Menu

Common Ankle Problems
Ankle Sprain (Lateral)
Affected Area
  • 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​
Affected Area
  • 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 more than 12/52 despite treatment
Plantar Heel Pain​
Affected Area
  • 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)​
Affected Area
  • Big toe pointing towards the other toes
  • Swollen, bony bump on the inside 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
Affected Area
  • 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 for long periods
  • Do not inject
  • Discuss weight loss
  • Advice
  • Exercise
  • Physiotherapy
  • Podiatry
  • NSAIDS
  • Simple analgesics
  • No investigations indicated in initial stages
  • Ultrasound may help to differentiate the nature of the thickening
  • If symptomatic and thickening/ growing
Pes Planus (flat feet)​
Affected Area
  • 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
Neuroma
Affected Area
  • 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 or Physiotherapy referral
  • NSAIDS
  • Simple analgesics
  • No investigations indicated in initial stages
  • If symptoms not improving after 12/52
  • Not managing with treatment
Ankle Pain / OA
Affected Area
  • 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