Ankle/Foot

MSK Physiotherapy for people with ankle and foot problems can be provided by either physiotherapy or podiatry services

For clinical support and referral guidance for podiatry please see: MSK Podiatry (nhslothian.scot)

M.A & P.A 15-09-23

Who not to refer/red flag presentations:	Serious pathology as a cause of MSK conditions is considered rare, but needs to be managed either as emergency or urgent referral to relevant secondary care service. Consider below & also see relevant body area tab for further specific information and advice. Please make sure all red flag concerns have been managed prior to any MSK Physiotherapy referral
Emergency conditions	Suspected septic arthritis Suspected acute Achilles tendon rupture Suspected fracture or dislocation
Urgent conditions	Suspected neurological deficit/ worsening neurological deficit- neurology referral Primary and secondary cancers- suspected New inflammatory arthritis -suspected
Consider serious pathology as a differential diagnosis if person presents with:	escalating pain and progressively worsening symptoms that do not respond to conservative management or medication as expected systemically unwell (fever, weight loss) night pain that prevents sleep due to escalating pain and/or difficulty lying flat
What not to refer – other:	Presence of significant red flags as detailed above Age <16 Non MSK complaints Recent foot/ankle surgery with complication- refer back to named Orthopaedic Consultant Surgeon Lumps and bumps Bunions, digital deformities People requiring orthotic provision

Who to refer:

People with foot and ankle problems who have not responded to initial primary care management, do not have the presence of significant red flags or other exclusion criteria, see below. Examples include ankle sprains, ankle instabilities, mild osteoarthritis (ankle, subtalar, midfoot), tendinopathies- Achilles, peroneal, tibilias posterior, plantar fasciitis.