Red flags for foor & 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:

  • Exclude Diabetes, Rheumatoid Arthritis and Ischaemia.
  • Immediate referral via Interface if infection or tumour are suspected or if the condition is worsening very suddenly.
  • If very urgent send to A&E.
  • Consider Diagnosis (discuss within peer review):
    • Fixed deformity
    • No Deformity
    • Tibialis posterior tendon injury
    • Sports related


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 and Oblique view only if injury suspected.

Podiatrist / Physiotherapist
  • Consider guidelines in previous section.
  • Assessment / Diagnosis.              
  • Detailed advice, Ice and stretching, taping and exercise
  • Advice re footwear, provide insoles, Aircast brace.
  • Treat corns, callosities and/or foot ulcer (Podiatry only).

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

Interface Team
  • Review previous assessment, diagnosis and management.
  • Consider steroid injection.
  • If no improvement after effective treatment; consider Bespoke Footwear refer to Orthotics Department.
  • If none of the above consider referral to surgeon.
  • Consider the following:
    • Willingness to undergo surgery.
    • General health.
    • Understand recovery period post surgery.

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 and Oblique view.
  • U/S or MRI if diagnosis unclear.
Surgical Criteria

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

  • No improvement despite 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


  • Referral to Orthotics department for bespoke footwear has been considered and undertaken (if appropriate) without desired improvement


  • 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 options include:

  • Surgical Fusion; this could permanently alter gait and the recovery period is 10-12 weeks to be able to drive (minimum) and 12 months to full recovery.
  • Tendon repair (recovery period 6-8 to drive (minimum) and 3-6 months to full recovery).
  • Osteotomy (recovery period 8-12 weeks to drive and 6-12 months  to full recovery.
  • Ankle arthroscopy (recovery period 4-8 weeks).