GGC MSK foot and ankleInitial Rehabilitation package –tailored to fit diagnosis 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 a problem serious to warrant escalation, but for all other cases a period of initial patient self directed rehabilitation should be given before any further intervention is considered.
Patient history and differential diagnosis
Warning
This is key to effective treatment of patients with Musculoskeletal (MSK) Foot and Ankle Conditions. All clinicians who will assess these patients need to have a minimum level of competency to be able to make a safe diagnosis, exclude red flags and place the patient on the correct evidence based pathway. MSK training should be designed to make sure all clinicians working in MSK Foot and Ankle can gain these competencies if these are not already gained at undergraduate level.
AHP Interventions should only be considered as a first line intervention if clinically justified or there is evidence to support an intervention as a first line treatment. Condition specific pathways should be followed to ensure consistency and equity of treatment for all patients across all AHP services in NHSGGC.
Interventions which are not supported by the current evidence base should not be used and these are clearly listed in the information for each pathway.
Most patients with an acute soft tissue injury or flare up of Osteoarthritis will usually present to the following:
- Emergency Department
- Minor Injuries
- GP
- Self referral to Physiotherapy
These services may offer:
- PEACE and LOVE (Protect, Elevate, Avoid anti-inflammatory modalities, Compress, Educate, Load, Optimisation, Vascularisation and Exercise)
- Advice on mobilisation / Issue of walking aid if appropriate
- Gait re education
- Advice on analgesia
- Further investigations
- Acute Sprains
Apply Ottawa rules for foot and ankle fracture. If positive refer to A&E.
Patient would then be referred to or self refer to MSK AHP and be placed on the appropriate pathway.
Patients who self-refer to MSK AHP post surgery should be advised that the referral cannot be accepted within 3 months of their surgery unless sent via the Orthopaedic Team.
Initial management during the healing/ recovery phase may include:
- Advice on mobilisation / Issue of walking aid if appropriate
- Gait re education
- Advice on analgesia
- Management plans specific to surgical interventions.
Follow-up management (greater than 3 months post op):
If patient requires longer term intervention they should then be referred to, or self-refer to MSK AHP and be placed on the appropriate pathway.