NHS AYRSHIRE AND ARRAN

MUSCULOSKELETAL FOOT AND ANKLE PATHWAY

For further information please contact:

Judith Reid, Consultant Physiotherapist in MSK,
Crosshouse Hospital.

Email; judith.reid.aapct.scot.nhs.uk
 STAGE ONE
Initial presentation of foot and ankle disorders

Red Flags for possible foot and ankle pathology. A patient presenting with
any of the following red flag signs or symptoms requires urgent referral

Unexplained swelling,
redness, pain; signs and Urgent referral to GP or
symptoms of infection A&E
Systemically unwell

Orthopaedics
Unable to weight-bear Urgent referral to A & E/
Signs and symptoms of Orthopaedics
fracture or tendon rupture

Sudden acute leg pain Urgent referral to A & E

Multiple joint pains Urgent referral to

Symptoms of Charcot foot indicated speciality
Diabetes/ Rheumatology
 STAGE TWO
GP Management

In absence of need for immediate referral

 Rule out infection, trauma

 Explain and reassure
 Return to normal activity or temporarily modify work as
soon as possible within the limit of the disability and pain
 Control symptoms
 Enable self-help / management
 Screen for Diabetes/ Inflammatory markers
 If symptoms of plantar fasciitis direct to self help and
ensure supportive footwear worn eg. trainers
 Use of ice, rest and over the counter arch support

National Rheumatiod Arthritis Society (NRAS)

 Do they have the S Factor?
 Stiffness – Early morning joint stiffness >30min
 Swelling – persistent swelling of one joint or more, especially hand
joints
 Squeezing – squeezing the joints is painful in inflammatory arthritis
 http://nras.org.uk/about rheumatoid arthritis/nras dvd for early
diagnosis .aspx
 Consider a referral to Rheumatology

Drug Therapy

Analgesics -
 Paracetemol
 NSAIDS
 Weak Opiods

Self Help / Information Resources

 Provide information / Patient Advice Leaflets

 www.arthritiscare.org.uk
 www.nhs.uk
 www.patient.co.uk
 www.nhsinform.co.uk
 STAGE THREE
REFERRAL

RECHECK FOR RED FLAGS IMMEDIATE OR URGENT

ORTHOPAEDIC / A & E
REFERRAL
In

IN ABSENCE OF RED FLAGS

CONSIDER ORTHOPAEDIC REFERRAL IF

 Severe / advanced OA
 Severe / advanced deformity
 Patient unwilling to change footwear to accommodate orthotic

CONSIDER REFERRAL TO MSK SERVICE IF

 Hallux Rigidus
 Hallux Valgus
 Morton’s Neuroma
 Ligament sprains
 Tendinopathies (Achilles,Peroneal,Tibialis Posterior)
 Osteochondrosis
 Posterior heel pain
 Toe deformities
 Pronated foot
 Supinated foot
 Metatarsalgia
 Paediatric flat foot
 Plantar Fasciitis
 Neurological deformity
 Early stage OA

CONSIDER WORKING HEALTH SERVICE (Appendix 2)

C

www.healthyworkinglives.com
www.salus.co.uk
Self refer: 0800 019 2211

PROCESS FOR REFERRALS TO MSK SERVICE

Electronic referral via SCI gateway with additional triage information to
‘MSK triage’
Please note: Referrals directed to Orthopaedics considered to be more
suitable for MSK will be redirected
 STAGE FOUR
AHP MSK SERVICE
FOOT and ANKLE
Re-evaluate for worrying Communication with
pathology, disorder not suitable
for MSK service
GP, referral returned or
redirected appropriately

Mild signs and Moderate signs and Severe signs and

symptoms symptoms symptoms

Consider Routine MSK Advanced

provision info service Practitioner/
with opt in. Self Podiatrist Combined Clinic
management/ /Physio/ (Injection, imaging)
Discharged Orthotics

If failing to progress after Orthopaedics

4 sessions - senior
clinician support

Other acute services

Pain services

Discharged