Foot / Ankle VFC

Soft tissue ankle injury / sprain

A&E management

Compression bandage, Walking boot (if severe), weight bear as tolerated

Follow-up

No referral needed. Refer to GP/MSK clinic if severe injury or clinical concern

Weber A ankle fracture

A&E management

Walking boot, crutches if needed

Follow-up

Walking boot, crutches if needed, weight bear as tolerated. (NO VFC or ortho referral needed)

Weber B ankle fracture

A&E management

Weight bearing x ray (mortise and lateral views without boot or cast).
If stable then provide walking boot, crutches if needed, weight bear as tolerated.
If unstable - Reduce fracture, below knee backslab, post-backslab XR

Follow-up

If stable - On-line referral to VFC. If unstable - Refer to Ortho on-call

Weber C / bi/trimalleolar ankle fracture / dislocations

A&E management

Reduce fracture, below knee backslab, post-backslab XR

Follow-up

Refer to Ortho on-call

Isolated medial malleolus fracture

A&E management

X-Ray full length tibia/fibula to rule out proximal fibula fracture.

Follow-up

On-line referral to VFC if undisplaced and no fibular fracture. Refer to Ortho on-call if displaced or associated fibular fracture

Calcaneal fracture

A&E management

Strict elevation, look for other associated injuries (e.g. spine)

Follow-up

Refer to Ortho on-call

Talus fracture

A&E management

Flake-avulsion fracture --> Walking boot, crutches if needed. Refer all others

Follow-up

Refer to VFC for flake-avulsion fractures All other talus fracture - Refer to Ortho on-call.

Metatarsal fracture

A&E management

Walking boot, crutches if needed

Follow-up

On-line referral to VFC if isolated fracture. Refer to Ortho on-call if multiple displaced fractures

Tarsal fracture

A&E management

Walking boot, crutches if needed

Follow-up

On-line referral to VFC

Phalanx fracture

A&E management

Reduce fracture, buddy strap, repeat XR

Follow-up

No referral required for stable lesser toe fractures. Refer to VFC if persistent deformity after reduction. (see more for details)

Achilles tendon rupture

A&E management

Arrange urgent outpatient Ultrasound to assess gap size. Walking boot with 3x wedges. Weight bear as tolerated. Supply 4 weeks of prophylactic Dalterparin. (See more for full protocol)

Follow-up

On-line referral to VFC