Ankle problems

• 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

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

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.

• Footwear advice
• POLICE (Protect, optimal Loading, Ice, Compression, Elevate)
• Sign post to NHS Inform - www.nhsinform.scot
• Sign post to NHS Doing More – www.dgdoingmore.co.uk

Issue condition specific patient leaflet:

• Achilles tendon pain
• Ankle injury

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.