Ankle problems

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

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.

Refer

If symptoms persist following 12 weeks of self management

Patients can self refer via SAP 030 3333 3001

They will be triaged into appropriate service i.e. Physiotherapy, Orthotist or Podiatrist.

SCI-Gateway referral should be completed for the following more urgent presentations:

Urgent referral

  • Previous complex fracture
  • Previous osteomyelitis
  • Non-healing wound
  • Sudden flat foot or sudden collapse of arch

Editorial Information

Last reviewed: 03/07/2026

Next review date: 03/07/2028

Reviewer name(s): Lynne Drennan.