{"id":7810,"date":"2022-07-12T16:50:03","date_gmt":"2022-07-12T15:50:03","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=7810"},"modified":"2026-08-18T09:12:46","modified_gmt":"2026-08-18T08:12:46","slug":"ankle-foot","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/ankle-foot\/","title":{"rendered":"Ankle\/Foot"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Physio-ankle-and-foot.pdf\" type=\"application\/pdf\" style=\"width:100%;height:1190px\" aria-label=\"Embed of Physio-ankle and foot.\"><\/object><a id=\"wp-block-file--media-aefb3416-804c-408a-802b-10bdcf97d905\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Physio-ankle-and-foot.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Physio-ankle and foot<\/a><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Physio-ankle-and-foot.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-aefb3416-804c-408a-802b-10bdcf97d905\">Download<\/a><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">MSK Physiotherapy for people with ankle and foot problems can be provided by either physiotherapy or podiatry services<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For clinical support and referral guidance for podiatry please see: <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/podiatry\/msk-podiatry\/\">MSK Podiatry \u2013 RefHelp<\/a><\/li>\n\n\n\n<li>For clinical support and referral guidance for orthopaedics, see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/foot-and-ankle-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Foot and Ankle Service \u2013 RefHelp<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-alert-red-color has-text-color has-link-color\"><tbody><tr><td><strong>Who not to refer\/red flag presentations:<\/strong><\/td><td><strong>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 &amp; also see relevant body area tab for further specific information and advice.<\/strong><br><strong>Please make sure all red flag concerns have been managed prior to any MSK Physiotherapy referral<\/strong><\/td><\/tr><tr><td><strong>Emergency conditions<\/strong><\/td><td><strong>Suspected septic arthritis<br>Suspected acute Achilles tendon rupture<br>Suspected fracture or dislocation<\/strong><\/td><\/tr><tr><td><strong>Urgent conditions<\/strong><\/td><td><strong>Suspected neurological deficit\/ worsening neurological deficit- neurology referral<br>Primary and secondary cancers- suspected<br>New inflammatory arthritis -suspected<\/strong><\/td><\/tr><tr><td><strong>Consider serious pathology as a differential diagnosis if person presents with:<\/strong><\/td><td><strong>escalating pain and progressively worsening symptoms that do not respond to conservative management or medication as expected<br>systemically unwell (fever, weight loss)<br>night pain that prevents sleep due to escalating pain and\/or difficulty lying flat<\/strong><\/td><\/tr><tr><td><strong>What not to refer \u2013 other:<\/strong><\/td><td><strong>Presence of significant red flags as detailed above<br>Age &lt;16<br>Non MSK complaints<br>Recent foot\/ankle surgery with complication- refer back to named Orthopaedic Consultant Surgeon&nbsp;&nbsp;<br>Lumps and bumps<br>Bunions, digital deformities<br>People requiring orthotic provision<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Refer via&nbsp;SCI Gateway&nbsp;Referral &#8220;AHP-Physiotherapy&#8221; then choose local site.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please provide as much detail as possible to help the triage process.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Signpost patient to:&nbsp; &nbsp;<\/strong><a href=\"https:\/\/services.nhslothian.scot\/orthopaedicfootankle\/\" data-type=\"link\" data-id=\"https:\/\/services.nhslothian.scot\/orthopaedicfootankle\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/IntegratedOrthopaedicFootAndAnkleService\/Pages\/default.aspx<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Support and guidance<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>For guidance and support refer to&nbsp;<a rel=\"noreferrer noopener\" href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLothianIntegratedOrthopaedicFootandAnkleService\/Pages\/default.aspx\" target=\"_blank\">http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLothianIntegratedOrthopaedicFootandAnkleService\/Pages\/default.aspx<\/a><\/li>\n\n\n\n<li>NHS Lothian patient website&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/orthopaedicfootankle\/\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/orthopaedicfootankle\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/IntegratedOrthopaedicFootAndAnkleService\/Pages\/default.aspx<\/a><\/li>\n\n\n\n<li>Foot and ankle examination guidance&nbsp;<a href=\"https:\/\/www.arthritis-uk.org\/health-and-care-professionals\/musculoskeletal-clinical-assessment\/clinical-assessment-of-patients-with-musculoskeletal-conditions\/the-musculoskeletal-examination-rems\/examination-of-the-foot-and-ankle\/\" target=\"_blank\" rel=\"noreferrer noopener\">Examination of the foot and ankle | Arthritis UK<\/a><\/li>\n\n\n\n<li>Foot and Ankle Pain&nbsp;<a href=\"https:\/\/www.arthritis-uk.org\/information-and-support\/understanding-arthritis\/conditions\/foot-and-ankle-pain\/\" target=\"_blank\" rel=\"noreferrer noopener\">Foot and ankle pain: Symptoms, causes and treatment | Arthritis UK<\/a><\/li>\n\n\n\n<li>Foot and ankle Osteoarthritis&nbsp;<a href=\"https:\/\/www.arthritis-uk.org\/information-and-support\/understanding-arthritis\/conditions\/osteoarthritis-OA-of-the-foot-and-ankle\/\" target=\"_blank\" rel=\"noreferrer noopener\">Osteoarthritis (OA) of the foot and ankle: Symptoms, causes and treatment | Arthritis UK<\/a><\/li>\n\n\n\n<li>For clinical support and referral guidance for podiatry please see:&nbsp;<a rel=\"noreferrer noopener\" href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/podiatry\/Pages\/What-We-Do.aspx\" target=\"_blank\">http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/podiatry\/Pages\/What-We-Do.aspx<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MSK-Self-Referral.docx\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MSK-Self-Referral.docx\" target=\"_blank\" rel=\"noreferrer noopener\">Physiotherapy Self Referral Form<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>MSK Physiotherapy for people with ankle and foot problems can be provided by either physiotherapy or podiatry services<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4160,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1090],"class_list":["post-7810","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-guidelines-musculoskeletalphysiotherapy-ankle-foot"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/https-apps-nhslothian-scot-refhelp-guidelines-musculoskeletalphysiotherapy-ankle-foot\/\" rel=\"tag\">Ankle\/Foot<\/a>","rttpg_excerpt":"MSK Physiotherapy for people with ankle and foot problems can be provided by either physiotherapy or podiatry services","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/7810","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=7810"}],"version-history":[{"count":24,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/7810\/revisions"}],"predecessor-version":[{"id":29537,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/7810\/revisions\/29537"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4160"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=7810"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=7810"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}