Sprained lateral ligament of ankle
- Elastoplast strapping or DTG.
- Advise analgesia and early mobilisation. Crutches are rarely needed.
- Review clinic at 10-14 days if swelling over both malleoli
- In children if the ankle is very painful there may be an undisplaced Salter Harris I injury. Consider a below-knee POP for symptomatic relief. Review Clinic in one week
Recurrent sprains
- Ask advice re stress x-ray
- If no instability refer physiotherapy.
Minor "chip" and avulsion fractures (less than 7mm)
- Treat as for sprains.
Undisplaced fracture of one malleolus
- Below knee POP; in unstable injuries re-x-ray to check position.
- Non weight bearing on crutches until POP dry
- Advise on analgesia/foot elevation/rest
- Refer Fracture Clinic
- In the elderly, who cannot be expected to be able to be non weight bearing consider the use of Dynacast to enable early mobilisation.
Displaced fractures of the ankle
- If severe bony displacement is causing pressure on the skin
- give analgesia and/or sedation and pull it straight (before X-ray if necessary)
- POP backslab
- Refer orthopaedics
Fracture of the calcaneum (If you suspect a fracture calcaneum, ask for calcaneal X-rays)
Displaced or involves subtalar joint: Elevate, analgesia and refer orthopaedics
Less severe fractures: Wool and crepe, and advice on elevation, Crutches
Fracture Clinic
These fractures may be bilateral and are associated with fractures of the spine/pelvis, so always examine the back/pelvis and x-ray if necessary.
Significant fractures of the Talus
Refer orthopaedics
Subtalar/ midtarsal dislocation
Refer orthopaedics
Ruptured Achilles Tendon
This is a clinical diagnosis
Refer orthopaedics
Partial tear of the gastrocnemius
- Exclude ruptured Achilles tendon (must do Simmond’s test - ask if uncertain)
- Crepe/tubigrip, Crutches if necessary
- Review Clinic one week
Fracture base of 5th metatarsal
- Symptomatic treatment, usually crepe/tubigrip but, if in severe pain, below knee POP.
- Crutches if necessary.
- Refer to Fracture Clinic or Review Clinic for follow-up
NB the epiphysis at the base of the 5th MT runs longitudinally, fractures are transverse
Fracture proximal shaft 5th metatarsal (Jones’ fracture)
Unlike 5th MT base fractures these have a high incidence of non union. Below knee POP Fracture clinic
Other metatarsal Fractures
Undisplaced - Symptomatic treatment as for fracture of the base of 5th M.T Fracture clinic
Displaced - Ask advice
If multiple fractures - Refer orthopaedics for possible admission for elevation.
Toe Fractures
Big toe
- No specific treatment
- Trephine subungual haematoma if necessary
- Advise on footwear/analgesia/elevation
Other toes
- Manipulate if displaced
- May be helped by neighbour strapping.
Toe dislocations
Reduce under local anaesthetic Neighbour strapping.
Most toe injuries need NO follow up. If follow-up is indicated, refer to Review Clinic