New York State Medical Treatment Guidelines for Ankle and Foot in workers compensation patients

The guidelines established by the New York State Workers’ Compensation Board serve as a tool to aid physicians, podiatrists, and healthcare professionals in delivering suitable treatment for ankle and foot disorders.

The primary purpose of these Workers’ Compensation Board guidelines is to support healthcare professionals in determining the optimal level of care for patients dealing with ankle and foot disorders.

It is crucial to note that these guidelines do not replace clinical judgment or professional expertise. The ultimate decision regarding patient care should be a collaborative process between the patient and their healthcare provider.

For workers’ compensation patients with ankle and foot disorders, the focus of medical care and treatment should be on restoring functional ability to meet the patient’s daily and occupational requirements. The primary goal is to facilitate a return to work while striving to restore the patient’s health to its pre-injury state to the extent practical.


Rendering of Medical Services:
Any medical professional providing treatment under workers’ compensation must adhere to the specified treatment recommendations for all work-related illnesses or injuries.

Positive Patient Response:
Positive outcomes are primarily identified through objectively measurable functional improvements. This includes aspects such as positional tolerances, range of motion, strength, endurance, activities of daily living (ADL), cognition, psychological behavior, and efficiency/velocity metrics. Subjective reports of pain and function are considered when they have anatomical and physiological linkage to the injury.

Re-Evaluate Treatment:
If a specific treatment or modality does not yield positive outcomes within a clearly defined timeframe, the clinician should adjust or discontinue the treatment regimen. Assessment of the therapy’s effectiveness should occur within two to three weeks following the initial visit and subsequent three to four weeks. Timelines may vary slightly for non-musculoskeletal medical illnesses (such as pulmonary, dermatologic, etc.) or conditions related to mental health.

Diagnostic Reassessment:
In cases of unexpectedly poor responses to otherwise rational interventions, clinicians should be motivated to reassess the diagnosis. Recognizing that therapeutic failure might occasionally be attributed to an inaccurate diagnosis or failure to respond prompts the need for diagnostic reconsideration.

Education: The treatment of work-related injuries or diseases should strongly emphasize educating not only the patient but also their family, employer, insurance, community, and policymakers. Practitioners should develop and implement effective educational plans and methods, starting with providing comforting information to the patient. A comprehensive treatment plan is incomplete without addressing individual and/or group patient education to facilitate self-management of symptoms and prevent future harm.

Time Frames for Ankle and Foot Disorders for Workers’ Compensation Patients:


  • Acute: Disease lasts less than one month
  • Subacute: One to three months
  • Chronic: Greater than three months

Initial Evaluation: The term “first evaluation” pertains to the time period following an injury, not necessarily when a specific physician initially analyzes an injured worker in an office or clinical setting.

Diagnostic Time Frames: Diagnostic testing must commence on the day of the accident within a time frame determined by the doctor. Adjustments to these time frames may be necessary based on individual circumstances.

Treatment Time Frames: Time frames for specific therapies begin after treatments have started, not on the date of the injury. The duration of treatment may vary based on disease severity, patient compliance, and service availability. Implementation speed may need adjustment based on individual situations.

Delayed Recovery: If a patient shows no improvement six to twelve weeks after an injury and if their symptoms do not align with objective test results, the diagnosis and treatment plan should be reassessed. Continuous assessment for potential barriers to recovery (yellow flags/psychological concerns) is essential. After six to twelve weeks, alternative treatment programs, such as professional psychological or social evaluations, should be considered. Recognition of existing or new psychological problems affecting healing is crucial. Referral to a mental health provider should occur sooner for issues immediately recognizable as mental health conditions. Evaluation and management of delayed recovery do not mandate the filing of a mental or psychological claim.

Treatment Approaches for Ankle and Foot Disorders for Workers’ Compensation Patients:

Active Interventions: As treatment progresses, active interventions that emphasize the patient’s responsibility, such as therapeutic exercise and functional treatment, receive more attention than passive modalities. Passive and palliative interventions are typically viewed as supportive measures to assist individuals in achieving their goals in an active rehabilitation program.

Active Therapeutic Exercise Program: Goals for an active therapeutic exercise program should encompass patient strength, endurance, flexibility, range of motion, sensory integration, coordination, cognition, and behavior. The program aims to enable the application of learned skills in a work or community setting as clinically indicated.

Diagnostic Imaging and Testing Procedures for Ankle and Foot Disorders for Workers’ Compensation Patients:

Selection of Diagnostic Techniques: Choosing diagnostic techniques and interpreting findings should be based on clinical data obtained through history taking and physical examination. Factors considered when deciding on diagnostic procedures include the reliability of the procedure for making a diagnosis, weighing the risks and benefits, available technology, the patient’s physical and mental capacity, and the practitioner’s familiarity with the procedure.

Repeat or Supplementary Diagnostic Testing: When a diagnostic examination, along with clinical data, provides sufficient information for an accurate diagnosis, no further testing is necessary. However, if the initial study is of poor quality, a subsequent diagnostic procedure, including a repeat of the original, can be performed when documented by the specialty physician, radiologist, or surgeon.

Monitoring Progress and Response to Treatment: Repeat imaging and other tests may be necessary to monitor a patient’s progress or response to treatment. This includes repeat diagnostic tests during treatment to re-evaluate or stage the condition with symptom progression, before surgical operations or therapeutic injections when clinically indicated, and after surgery to track the healing process.

Considerations for Repeat Examinations: Repeat examinations, particularly x-rays (such as CT scans), should be approached with caution due to increased overall radiation exposure and associated hazards. Diagnostic imaging procedures may offer unique or additional information, and judicious selection of procedures for a single diagnosis or in combination ensures maximum accuracy while minimizing negative effects and optimizing efficiency by avoiding duplication or unnecessary steps.

Surgical Interventions for Ankle and Foot Disorders for Workers’ Compensation Patients:

Surgery should be considered only in the context of expected functional outcomes, as the term “cure” in relation to surgical treatment can be misleading. Every surgical operation must be supported by evidence demonstrating a strong correlation between clinical symptoms, clinical trajectory, and diagnostic testing, including imaging.

A precise diagnosis, confirmed by pathological findings, must be established through a thorough integration of these criteria. Surgery should be utilized to address pain only when there is an objectively proven direct link between the pain’s symptoms and cause. In decision-making, it is crucial to consult the patient, providing them with a comprehensive understanding of the advantages and disadvantages of surgery, potential rehabilitation alternatives, evidence-based outcomes, and the specifics of the surgical experience.

Pre-Authorization for Ankle and Foot Disorders for Workers’ Compensation Patients:

All diagnostic imaging, testing, non-surgical and surgical therapeutic procedures, and other therapies meeting the Workers’ Compensation Board Medical Treatment Guidelines criteria and appropriately applying the guidelines are considered approved. However, procedures not listed in the pre-authorized operations require pre-authorization from the carrier before providers can proceed with their execution.

Pre-authorization is also necessary for second or subsequent treatments that involve the repetition of a surgical procedure due to the failure or incomplete success of a previous surgical procedure, provided the Workers’ Compensation Board Medical Treatment Guidelines do not specifically cover multiple procedures.

Psychological/Psychiatric Evaluations for Ankle and Foot Disorders for Workers’ Compensation Patients:

In certain cases, evaluations of the patient’s mental health may be necessary to establish, support, or confirm a diagnosis. The depth and duration of assessments and interventions by mental health specialists may vary, depending on whether:

  1. There is a mental health issue related to or resulting from the medical injury or illness in question.
  2. The underlying clinical issue in the claim is a mental health problem.
  3. There is a mental health problem secondary or consequential to the medical injury or illness.
  4. There is a pre-existing, unrelated mental health issue exacerbated by or impeding recovery from the medical injury or illness.

Psychological tests can be valuable in identifying associated psychological, personality, and psychosocial issues, but they cannot provide a diagnosis. A diagnosis is established only after a thorough examination of all relevant information, including a complete history and clinical interview.

Having a professional proficient in the patient’s mother tongue is strongly desirable. If not available, a qualified language interpreter should be employed. For cases involving a pre-existing, unrelated mental health issue worsened by or hindering recovery from a work-related medical injury or illness, a single visit for the initial psychiatric or psychological encounter should typically suffice.

Continuation of Care: Typically, care would be continued by the previous treating provider. If the initial consultation results indicate the necessity for psychometric testing, the time required for such testing should not exceed an additional three hours of professional time.

For conditions where a mental health issue is a key component of the initial claim or is secondary to or consequential to the work-related illness or injury, more extensive diagnostic and therapeutic interventions may be clinically indicated. The details of such mental health conditions are covered in the Medical Treatment Guidelines.

Personality/Psychological/Psychosocial Intervention for Ankle and Foot Disorders for Workers’ Compensation Patients:

When an intervention is recommended following a psychological examination, it should be implemented as promptly as possible, either independently or in combination with other therapeutic approaches. A treatment plan with measurable behavioral goals, time constraints, and specific interventions must be prepared for all psychological and psychiatric interventions.

Time Frames for Effects to Manifest:

  • Two to eight weeks for effects to manifest.
  • Ideal time frame: between six and three months.
  • Three to six months at the most.
  • Counseling is meant to expedite functional recovery rather than postpone it.

Psychological Treatment for PTSD:

  • Ideal time frame: three to six months.
  • Nine to twelve months at the most.

Longer supervision and treatment may be necessary for some patients. If additional treatment is recommended, the authorized treating practitioner should provide documentation every four weeks for the first six months of treatment, projecting a reasonable functional prognosis. For treatment anticipated to last six to twelve months, documentation should be provided every four to eight weeks. For long-term treatment exceeding twelve months, documentation should be given every eight to twelve weeks. All parties involved should maintain continuous communication to ensure smooth, uninterrupted treatment.

Functional Capacity Evaluation (FCE) for Ankle and Foot Disorders in Workers’ Compensation Cases:

A comprehensive assessment of various aspects of function related to a patient’s ability to return to work is known as a functional capacity evaluation (FCE). It evaluates characteristics of competitive employment, including endurance, lifting (both dynamic and static), postural tolerance, specific range-of-motion, coordination, strength, worker habits, and employability.

Components of FCE:

  • Musculoskeletal screen.
  • Cardiovascular profile/aerobic capacity.
  • Coordination.
  • Lift/carrying analysis.
  • Job-specific activity tolerance.
  • Maximum voluntary effort.
  • Pain assessment/psychological screening.
  • Non-material and material handling activities.
  • Cognitive and behavioral.
  • Visual.
  • Sensory perceptual factors.

In most cases, determining if a patient can resume work can be done without using an FCE. An FCE may be considered at the time of Maximum Medical Improvement (MMI) when the treating physician is unable to definitively decide on work status at case closure. However, an FCE is not recommended early in a treatment regimen for any reason, including supporting a therapy strategy.

Considerations in FCE Interpretation:

  • The treating physician must understand and consider job responsibilities when using an FCE to determine return to a specific employment site.
  • Determination of work limits cannot solely rely on FCE results.
  • The authorized treating physician should interpret the FCE in light of each patient’s unique presentation, medical history, and subjective experiences.
  • FCEs should not be the sole factor considered when diagnosing malingering.

Return To Work for Ankle and Foot Disorders in Workers’ Compensation Cases:

For these recommendations, “return to work” refers to any task or responsibility that the patient can safely carry out. The patient’s regular work may not be included, and it should be discussed at each outpatient visit as part of the treatment and rehabilitation plan. The plan should include a description of the patient’s condition and task restrictions, serving as the rationale for limiting work duties as necessary. Early return to work should be the primary goal of occupational injury treatment, as the likelihood of getting an injured worker back to work decreases over time. The focus is on guiding patients along a continuum of care to facilitate a timely return to work.

Job Site Evaluation for Ankle and Foot Disorders in Workers’ Compensation Cases:

The treating physician may engage with the employer or their representative through in-person meetings, video conferences, or phone calls to understand the unique requirements of the patient’s pre-injury employment. This involves gaining insights into the physical demands of the job, such as repetitive tasks, heavy lifting, static postures, environmental exposures, and psychological stressors that could impede re-entry, heighten the risk of reinjury, or hinder the healing process.

Inquiries should be made about modified duty work settings aligning with the patient’s condition when returning to previous job tasks or settings is impractical due to clinically determined restrictions. Ideally, an on-site examination of work environments and activities would provide the most valuable information, though this may not always be feasible. Job-related films, CDs, DVDs, or video conferences from the workplace can serve as valuable sources of information.

Contacts with the employer occur in two phases:

  1. First Contact: The patient is functioning and capable of performing some work.
  2. Second Contact: The patient has progressed to a point where handling higher functional demands in a workplace is feasible.

The physician must record details of these discussions.

Guideline Recommendations and Medical Evidence: The scientific medical literature supporting the guidelines has not undergone independent review by the Workers Compensation Board or its Medical Advisory Committee. Instead, reliance is placed on the development processes of other guidelines used and cited in these guidelines.

Experimental/Investigational Treatment: These guidelines strictly prohibit the use of experimental or investigational medical treatments lacking FDA approval for any purpose, application, or indication.

Assistance for Ankle and Foot Injuries: The office has the experience to assist with workers’ compensation injuries, addressing medical needs while adhering to New York State Workers Compensation Board guidelines. The team understands the complexity of workers’ compensation cases, offering support in navigating the process with the insurance company and the employer.

Recognizing the stress associated with such situations, the office aims to ease the process for individuals and their families. Appointments can be scheduled for those seeking assistance, ensuring dedicated support during this challenging time.

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