The injured ankle and foot
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2901 (Published 07 August 2009) Cite this as: BMJ 2009;339:b2901
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Mayer describes how clinical prediction rules may avoid unnecessary
investigation of the injured ankle and foot.1
However, users of any set of rules need to know their limitations.
Patients with diabetes and severe distal sensorimotor neuropathy can
present with a bruised and swollen foot as a result of a bony injury but
can remain free from pain and still fully able to weight bear without
complaint. Such injuries may have occurred without any clear antecedent
history or after apparently trivial trauma.
In this scenario, the absence of pain is no reassurance against there
being a bony injury. Walking with ease on a red, hot swollen foot is
highly abnormal and a thorough clinical and radiological assessment is
essential.
Failure to diagnose such an injury early on and put in place
appropriate off-weight bearing measures can result in severe deformity and
disability.
1 Mayer D. The injured ankle and foot. BMJ 2009;339:b2901.(15 Aug.)
Competing interests:
None declared
Competing interests: No competing interests
Erratum - credo
I think that, in "the Ottawa ankle rules ... have 98% sensitivity and
40% specificity for excluding fractures", "excluding" should read
"diagnosing".
Competing interests:
None declared
Competing interests: No competing interests