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):

  • exclude referred spinal pain.
  • Onward referral to podiatrist if no improvement in 6 weeks.


  • Optimal analgesia/ NSAIDS.
  • Appropriate footwear with sufficient arch support and cushioned heels.
  • Purchase of ‘over the counter’ gel heel cup.
  • Modify activity.
  • Weight reduction and/or smoking cessation if applicable.

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 only if injury suspected.

  • Consider guidelines in previous section.
  • Assessment/Diagnosis.
  • Detailed lifestyle advice.
  • Provide Insoles/ Heel cups etc.
  • Calf and plantar fascia stretch & Exercise.
  • Taping.

If no improvement after approximately 3 months of comprehensive management refer on to the Interface Team

Interface Team
  • Review previous assessment, diagnosis and management.
  • Splints, walking casts and braces can be used for resistant heel pain.
  • Consider steroid injection.
  • If 2 steroid injections have not relieved symptoms discussion regarding onward referral.
  • Consider the use of night splints.
  • Gait Analysis.
  • If none of the above consider referral to surgeon.
  • Consider referral to Pain Consultant.


  • Steroid injection can be given under U/S guidance.
  • U/S or MRI for complex diagnosis or pre-referral for surgery.
Surgical Criteria

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

  • No improvement despite 3-6 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 opinion/management/surgery by an orthopaedic consultant


  • 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

This condition is not generally helped by surgery but interventions that can be used are:

  • Plantarfascial release or if nerve related Tarsal Tunnel Decompression (recovery period 6 weeks minimum).
  • Extracorporeal Shockwave Therapy (current research project).