When is PT not appropriate for foot pain?

In some cases, patients presenting with hip pain will be referred to a different provider. While this is rare, we want to be certain we, as physical therapists, are able to help.

Some of the symptoms we look for include:

• Fever, chills, night sweats (increased risk of infection or cancer)
• Weight loss (concern of cancer or infection)
• Recent infection (increased risk of infection)

Medication-specific concerns include:

• Steroids (risk of osteoporosis)
• Anti-coagulants (risk of bleeding)
• Immunosuppressants (risk of infections)

The Ottawa Foot Rules were created to determine if a patient needs X-rays following an acute foot injury. A patient needs X-rays if there is:

• Pain in the midfoot zone (see image below)
• Any of the following:
  • Bone tenderness along the base of the 5^th metatarsal, or
  • Bone tenderness at the navicular bone, or
  • An inability to bear weight both immediately and in the emergency department for four steps

  

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  References:

  1. Stiell, Ian G. “Implementation of The Ottawa Ankle Rules.” JAMA: The Journal of The American Medical Association, Vol. 271, No. 11, 1994, p. 827. American Medical Association (AMA), https://doi.org/10.1001/jama.1994.03510350037034.
  2. http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf

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