- Can be post traumatic (after calcaneus fracture), but can also occur in inflammatory and osteoarthritis.
- Patients typically complain of pain on one or both sides of the foot below the malleoli, ankle stiffness, and difficulty walking on uneven ground.
- Examination may reveal restricted subtalar varus/valgus, with tenderness over the sinus tarsi or inferior to the malleoli.
- Blood tests and radiography are not usually indicated as part of a primary care assessment of suspected osteoarthritis but may be indicated in cases of diagnostic uncertainty.
NICE recommend Core treatment should be offered to all patients for a minimum 3/12 prior to referral for surgical opinion.
- Provide verbal and written information to patient. Limit walking on uneven ground.
- Advise strengthening exercises and aerobic fitness training including cycling and swimming.
- Advise comfortable shoes (+/- heel shock absorber) or an ankle brace.
Analgesia should include:
- Regular paracetamol.
- Topical NSAIDs.
- Consider oral NSAIDs, opiods, intra-articular steroid injection (XR-guided). Utilise the NHS shared decision making aids (URL).
- Diagnostic uncertainty.
- Failure of minimum 3/12 conservative measures.
- Pain, stiffness, reduced function impacting on QoL.
- Referral for physiotherapy / orthotics.
- Referral for steroid injection, consideration of fusion.