Warning

Presentation

  • Sudden onset of pain following traumatic injury
  • Previous history of ankle injuries
  • Intermittent pain related to activity

Symptoms/signs

  • unable to weight bare
  • increase pain and stiffness first thing in the morning
  • Achilles tendon pain
  • gradual onset
  • OTTAWA guidelines
  • haematoma
  • bruising
  • swelling
  • loss of use
  • deformity
  • positive Thomson’s squeeze test
  • positive anterior drawer test
  • positive Talar test

Differential diagnosis

  • Achilles tendon rupture
  • Insertional achilles tendonopathy
  • Retrocalcaneal bursiitis
  • Systemic Inflammatory Disease (think septic arthritis)
  • soft tissue injury (Ligament/tendon, rupture/strain)
  • Dislocation/fracture

Primary care management

Evidence suggests that 80% of MSK problems are self limiting and will recover within 12-18months. It is important to rule out serious pathology or any problem that warrants escalation but for all other cases a period of initial self directed rehabilitation should be given before any further intervention is considered.

 

Issue condition specific patient leaflet:

  • Achilles tendon pain
  • Ankle injury

Refer

If symptoms persist following 12 weeks of self management.

Refer via SAP/appropriate referrers to MSK pathway

Triaged into appropriate service i.e. Physiotherapy, Orthotist or Podiatrist.

Editorial Information

Last reviewed: 05/07/2024

Next review date: 06/07/2026

Reviewer name(s): Lynne Drennan.