Foot and Ankle Service

This page was last reviewed 08-01-21

Service

The Foot and Ankle team is a multi-professional group consisting of orthopaedic surgeons, podiatrists, orthotists and nurses. All GP referral letters to the Foot and Ankle service are initially screened (eTriage) by one of the team and patients are triaged to the appropriate clinician. If it is a case where conservative measures are appropriate then they will see the podiatrist or orthotist, otherwise they will be referred to the orthopaedic surgeons. Generally the surgeons, podiatrist, orthotists and nurse work in the same location and so there is close communication between the disciplines and potential for inter-disciplinary referral. The Foot & Ankle team includes a Consultant Podiatrist who has specialised in orthopaedics for many years and has gained additional training to allow him to work as a member of the operating team. The consultant podiatrist is fully capable of performing forefoot procedures to the highest standards and patients receive the same care as provided by a surgeon. The specialist orthopaedic nurse is involved with the pre-assessment of patients and the post-operative management of patients.

Who to refer:

Urgent Referral

Non-traumatic conditions such as:

Infection
Tumour

Routine referral

It is expected that for most of the following conditions, conservative measures such as Podiatry, Physiotherapy and Orthotics have been tried first of all. Suitable patients have foot and ankle pain or deformity requiring specialist orthopaedic care, consideration for operative procedures or specialist investigation. Examples of suitable conditions suitable for referral are listed below.

Forefoot problems

Hallux Valgus. Hallux valgus, often referred to as “a bunion” is a deformity of the big toe (1st MTP joint). The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot. (A bony lump on the top of the big toe joint is usually due to a different condition, called hallux rigidus.) Sometimes a bursa develops over the medial prominence of the 1st MTP joint.{/mostip}
Hallux rigidus. Hallux rigidus is arthritis of the main joint of the big toe (1st MTP joint). It is a wearing out of the joint surfaces. It is called “hallux rigidus” because its main feature is stiffness (“rigidus”) of the big toe (“hallux”). Sometimes only the upper part of the joint is affected and the rest of the joint is all right. In other people the whole joint is worn out.
Problems with small toes. The main problem with deformed toes is that they tend to rub on shoes, either on top of the PIPJ or at the tip, or both. This rubbing may simply be uncomfortable, or the skin may ulcerate. If the MTP joint is bent upwards, particularly if it is stiff, the toe may press down and cause pain in the ball of the foot (“metatarsalgia”). Bent toes may rub on one another or on the big toe, especially if the big toe is bent towards the second toe (hallux valgus or bunion).{/mostip}
Metatarsalgia (pain in the ball of the foot)

Morton’s neuroma
Freiberg’s infraction
March fracture
MTP joint synovitis

Morton’s neuroma

can be treated by the community podiatrists who will offer:

footwear advice
insoles
steroid injections

Please do not refer directly to radiology requesting ultrasound scans for suspected Morton’s neuroma.

Hind foot problems

Ankle ligament problems/instability
Ankle joint problems
Retrocalacaneal bursitis
Tibialis posterior dysfunction

Mid foot problems

Midfoot arthritis

Whole foot problems

Pes cavus (high arched foot)
Pes planus (flat foot)

Other/Miscellaneous conditions

Ganglia
Plantar fibromatosis
Tarsal tunnel syndrome

Who not to refer:

The following conditions are best seen by the podiatrists in the community service.

Ingrowing toenails
Fungal nails
Verrucae
General podiatry
Treatment of skins conditions (corns and callous)

The following conditions are best seen by the podiatrists in the community, in the first instance. If conservative measure have failed, then it is appropriate to refer patients to the orthopaedic Foot & Ankle service.

Plantar fasciitis
Morton’s neuroma
Achilles tendinopathy

There is an open access service and patients do not necessarily require a GP referral, patients can refer themselves by contacting:
MSK Clinic
Department of Podiatry
Springwell House
Ardmillan Terrace
Edinburgh
EH11 2JL
0131 537 7469
0131 537 7470
Or
Mary Gray
Administrator
Department of Podiatry
Queen Margaret University
0131 474 0000

mgray@qmu.ac.uk This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Children under 14 should be referred to the Royal Hospital for Sick Children Edinburgh where there is a paediatric orthopaedic service.

How to refer:

Referral letter guidance

Full demographics with contact telephone numbers.
Nature of condition and duration.
Relevant past medical history.
Results of previous x-rays (or other investigations) together with a copy of the reports
All medication currently and previously used for this condition including dose, duration of treatment and response, plus all other concurrent medication.

Use Gateway. SCI Gateway is launched via GP application. If Gateway not available, use standard referral letter for referrals to RIE\SJH\Trauma & Orthopaedics. The Hand clinic can be accessed on Gateway via SJH\Trauma & Orthopaedics\Hand Clinic
GPs in the NE and SE localities can use the MSK service at Mountcastle

(Gateway: Mountcastle Primary Care Centre\Orthopaedics – Musculo-Skeletal)