Red flags for foot & ankle conditions

Prior to referral consider / screen to exclude:

Key Clinical Observations of concern:

  • Hot / red / swollen joint with raised body temperature .
  • Rapidly worsening deformity .
  • Inability to weight bear.
  • Neuro-vascular compromise.
Urgent foot & ankle referral

Acute infection or suspected new traumatic injury should be sent to A&E.

Urgent appointments can be made for patients in consultant led orthopaedic F&A fracture clinic.

  • On going infection
  • Suspected tumour
  • Ankle injury
  • Charcot Arthropathy

Urgent appointments can be made in consultant orthopaedic foot and ankle elective clinics for patients with:

  • Rapidly worsening symptoms.
  • Complex conditions requiring diagnosis.
  • Patients with associated medical conditions e.g. Charcot Marie Tooth Syndrome.

Urgent appointments can be made with podiatrists for:

Consider diagnosis (discuss within peer review):

  • Consider deformed foot.
  • OA /Degenerative ankle.
  • Tendinopathy.
  • Adult acquired Flat Foot.


If no improvement; suggest self referral or refer on to Physiotherapy or Podiatry Service for diagnosis (if not already ascertained) and treatment.


AP/Mortise and lateral standing foot X-ray prior to onward referral if first line actions fail or if patient reports sharp catching or locking.

Physiotherapist / Podiatrist
  • Consider guidelines in previous section.
  • Assessment/Diagnosis.
  • Detailed advice.
  • Manual therapy/exercise.
  • Consider insoles (Podiatry more likely to provide this service especially if more complex types required).

If no improvement after approximately 3 months of comprehensive treatment refer to the Interface team.

Interface Team
  • Review previous assessment, diagnosis and management.
  • Walking cast/ brace if necessary.
  • Consider Steroid Injection.
  • If symptoms are not relieved discussion regarding onward referral.
  • If none of the above and fits criteria consider referral to surgeon.

If patient does not wish to explore surgical option refer back to GP or Pain Consultant for advice regarding analgesia.


  • AP/Mortise and lateral standing foot X-ray prior to onward referral if first line actions fail or if patient reports sharp catching or locking.
  • Steroid injection can be given under U/S guidance.
Surgical Criteria

No referrals to secondary care unless the following criteria are met:

  • No improvement despite 3 months of conservative management


  • The patient has shown commitment to weight reduction through active participation in a weight management programme if the patient's BMI is >30


  • Review by Interface suggests patient likely to benefit from further management/surgery by an orthopaedic consultant


  • AP/Mortise and lateral standing foot X-ray undertaken prior to referral


  • Steroid injection has been considered and undertaken (if appropriate)


  • Health Care Professional has discussed surgery with the patient who has confirmed they want explore surgery


  • General Health including fitness for anaesthesia has been considered and believed adequate to proceed to potential surgical intervention and it is believed that the patient is likely to derive quality of life benefits from surgery

Surgical interventions include:

  • U/S Guided steroid injection.
  • Fusion (This could permanently alter gait and the recovery period is 6-12 weeks non weight bearing, 3-4 months in a brace or cast and approximately 12 months to full recovery).