New York State Medical Treatment Introduction for Ankle
and Foot Disorders for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for ankle and foot disorders.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Introduction for Ankle and Foot Disorders

This recommendation deals with common and potentially occupational ankle and foot ailments. It includes evaluation, such as spotting “red flags” or warning signs of potentially serious injury or illness, diagnosis, diagnostic tests to identify clinical pathology, and care. Fracture, dislocation, cancer, metabolic problems, infection, and other illnesses are all warning signs.

History Taking and Physical Examination for Ankle and Foot Disorders

Physical examination and history-taking lay the groundwork for and direct the progression of diagnostic and therapeutic procedures. When findings from clinical evaluations and those from other diagnostic techniques do not agree, preference should be given to the objective clinical findings. The following should be appropriately documented in the medical records:

History of Present Injury for Ankle and Foot Disorders

• The mechanism of damage, which includes information on the development and course of symptoms as well as symptoms that could develop as a result of postural or functional adaptation to the ankle-foot injury;

   

• Work-relatedness: This comprises a declaration of the likelihood that the ailment or injury is work-related;

   

• Prior injuries, both occupational and non-occupational, to the same location, including any previous specialised treatments;

   

• The capacity to carry out daily tasks and occupations;

   

• Symptom-exacerbating and -alleviating factors, not just for the ankle-foot.

Past History for Ankle and Foot Disorders

• Past medical history may have included diabetes, gout, arthritis, and neoplasms;

   

• Symptoms of rheumatologic, neurologic, endocrine, neoplastic, and other systemic disorders are included in the review of systems, but are not exclusively so;

   

• Past use of tobacco;

   

• Career and leisure activities;

   

• Previous imaging research; and

   

• Prior surgical experience.

Physical Examination for Ankle and Foot Disorders

A joint should be examined from both the top and bottom, as well as the opposite side for comparison. A physical examination should use procedures and tests that are appropriate for the joint or area being evaluated, such as:

• Visual inspection – Look for and notice asymmetries and abnormalities that may indicate degeneration, malformation, fracture, or dislocation. Examine both feet. Keep an eye out for any significant wounds, such as crush wounds, degloving wounds, lacerations, puncture wounds, and open wounds;

   

• Palpation;

   

• Quality and range of motion (active and passive); Both actively and passively measuring the foot and ankle’s range of motion (ROM) is necessary. Mobility on the affected and unaffected sides should be compared;

   

• Strength versus atrophy or weakness;

   

• Joint stability and integrity – Stress the ligaments to determine stability and compare to the unaffected side on the opposite side;

   

• a deformity/displacement check; and

   

• As clinically appropriate, evaluate the neurologic (motor, sensory, and reflex) and vascular status of the foot and ankle, including the distal circulation’s integrity, peripheral pulses, and skin temperature. Keep an eye out for any indicators of significant wounds, such as degloving, lacerations, puncture wounds, open wounds, and crush wounds.

Assessing Red Flags for Ankle and Foot Disorders

“Red flags” or certain findings highlight the possibility of significant medical issues. The review of the history and physical examination should include looking for warning signs. These observations or signs in the foot and ankle may include compartment syndrome, fractures, dislocations, infections or inflammation, tumours, tendon ruptures, and infections or inflammation.

The New York Ankle and Foot Injury Medical Treatment Guidelines contain modifications in clinical management triggered by the existence of “red flags,” and further evaluation/consultation or urgent/emergency action may be necessary.

Diagnostic Criteria and Differential Diagnosis for Ankle and Foot Disorders

Diagnostic tests are typically not required until after a period of conservative therapy and observation in the majority of people presenting with genuine foot and ankle diseases. Once any warning signs are eliminated, the majority of ankle and foot issues soon get better.

During the first month of activity restriction, routine diagnostics, such as lab tests, plain-film radiographs of the foot or ankle, or special imaging studies, are not advised, unless a history or examination finding raises suspicion of a serious foot or ankle problem or of referred pain.

Diagnostic Testing and Procedures for Ankle and Foot Disorders

One diagnostic imaging procedure might offer information that is similar to or unique from that found by other procedures. In order to ensure maximum diagnostic accuracy, minimise negative effects on patients, and promote cost effectiveness by avoiding duplication or redundancy, it is wise to choose the procedure(s) for a single diagnostic procedure, a complementary procedure in combination with other procedure(s), or a proper sequential order in multiple procedures.

There is a sizable proportion of specificity and sensitivity for various diagnoses in all diagnostic imaging methods. None of them are distinctive to a particular diagnosis. The choice of imaging procedure and the interpretation of the data should be based on clinical information gathered during the history-taking and physical examination.

The second diagnostic process will be unnecessary if it is carried out only for diagnostic reasons when a diagnostic procedure, along with clinical data, gives adequate information to produce an appropriate diagnosis.

Likewise, if the first or previous procedures, when combined with clinical data, are unable to provide an accurate diagnosis, a subsequent diagnostic procedure (which may be a repeat of the same procedure, depending on whether the rehabilitation physician, radiologist, or surgeon documents that the study was of inadequate quality to make a diagnosis) can be a complementary diagnostic procedure. Typically, choosing one technique over another depends on the procedure’s availability, the patient’s tolerance, and/or the treating professional’s expertise with it.

It is acknowledged that in some circumstances repeat imaging exams and other tests may be necessary depending on the clinical course and to monitor the effectiveness of the treatment.

In order to reassess or stage the pathology when symptoms or findings progress, before surgical treatments and therapeutic injections where necessary, and post-operatively to monitor the healing process, it may be beneficial to repeat diagnostic techniques (such as imaging investigations). It is important to understand that repetitive CT exams result in a higher cumulative radiation dosage and associated dangers.

Based on the mechanism of injury, symptoms, and patient history, the following can be used to further evaluate foot and ankle injuries when necessary.

What our office can do if you have workers compensation Ankle and Foot injury

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.