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  7. When is PT not appropriate for foot pain?

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 5th metatarsal, or
    • Bone tenderness at the navicular bone, or
    • An inability to bear weight both immediately and in the emergency department for four steps


    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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