Ankle/Foot pain
COVID-19 clinical presentation <div class="redbox"> <p style="text-size:12px;">COVID-19 can present with a myriad of symptoms so should probably be on most differential diagnosis lists during the pandemic</p> <li><a href="https://productivemedic.com/covid-remote-assessment/" target="_blank">COVID assessment, DDx and complications</a></li> <li><a href="https://www.google.com/imgres?imgurl=https%3A%2F%2Ff6publishing.blob.core.windows.net%2F2ab0884c-0618-4586-aaf1-41004e6ad656%2FWJCC-8-3956-g002.png&imgrefurl=https%3A%2F%2Fwww.wjgnet.com%2F2307-8960%2Ffull%2Fv8%2Fi18%2F3956.htm&tbnid=I0G0VvXcx_akPM&vet=12ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ..i&docid=IBDQMbzRItpvKM&w=3307&h=2168&q=covid%2019%20presentation&safe=strict&ved=2ahUKEwj1_43FsrnuAhUH-YUKHSoZAFQQMygYegUIARCwAQ" target="_blank">Clinical presentation summary infographic</a></li> <div>
*Common causes
*Must not miss!
  • Ankle / Foot Bone fracture
  • Achilles tendon rupture
  • Septic arthritis
  • Acute limb ischaemia <div style="text-align:center;"> <a href="https://www.bmj.com/content/360/bmj.j5842" target="_blank">Peripheral artery disease</a><br> <a href="https://www.bmj.com/content/bmj/suppl/2018/02/01/bmj.j5842.DC1/morr041877.wi.pdf" target="_blank">BMJ infographic</a> </div>
  • Non-venous ulceration
  • Diabetic foot <div style="text-align:center;"> <a href="https://www.bmj.com/content/359/bmj.j5064" target="_blank">Diabetic foot</a><br> <a href="https://www.bmj.com/content/bmj/suppl/2017/11/16/bmj.j5064.DC1/chas041916.ww1.pdf" target="_blank">BMJ inforgraphic</a> </div> (painless)
  • Osteomyelitis
*Easily missed
  • Morton's neuroma
  • March fracture
  • Painful Peripheral neuropathy
  • Diabetic foot <div style="text-align:center;"> <a href="https://www.bmj.com/content/359/bmj.j5064" target="_blank">Diabetic foot</a><br> <a href="https://www.bmj.com/content/bmj/suppl/2017/11/16/bmj.j5064.DC1/chas041916.ww1.pdf" target="_blank">BMJ inforgraphic</a> </div> (painless)
Red flags
  • Not weight-bearing
  • Cold pulse-less leg
  • Loss of bladder or bowel control
  • Hot/painful/swollen joint with little movement
  • Sudden severe achilles pain with foot drop
  • Ulceration/cellulitis
  • Systemic symptoms (fever, weight loss)
Investigations to consider
  • FBC, CRP/ ESR, serum glucose
  • Auto-antibody screen, Rheumatoid factor +/- anti-CCP antibodies
  • Serum uric acid
  • Local X-ray
  • Blood culture
  • MRI scan
  • Nerve conduction studies
  • Bone scan
  • ABPIs
  • Angiography
* DDx list disclaimer: please read
  • These lists could never be comprehensive and remain practical to use during the consultation. We have included conditions that we think will cover the vast majority of primary care presentations for any given symptom. This does not mean other conditions, red flags and investigations should not be considered.
  • Each list is provided as a brief reminder only and is presented in no particular order. The authors have used editorial licence to allow quicker access during the consultation and to prevent duplication.
  • We feel that the "Must not Miss" conditions should always appear at the top of your differential diagnosis list. The consequences of missing a diagnosis from within this category carry significant morbidity and mortality risks to your patient.
  • Many diagnoses are not obvious or apparent at the initial presentation. It may be appropriate to share your diagnostic uncertainty with patient, and also provide specific guidance (safety netting) on when and where patients should seek further advice and follow up.