Ankle and Foot Injuries

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