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

The guidelines provided by the New York State Workers Compensation Board are designed to aid physicians, podiatrists, and other healthcare professionals in delivering suitable treatment for ankle and foot disorders.

These guidelines from the Workers Compensation Board are meant to support healthcare professionals in determining the right level of care for patients with ankle and foot disorders.

It’s important to note that these guidelines should complement clinical judgment and professional expertise. The final decision regarding care should be a collaborative process between the patient and their healthcare provider.


Introduction for Ankle and Foot Disorders

This advice addresses prevalent and potentially work-related issues concerning the ankle and foot. It encompasses assessment, recognizing “red flags” or indicators of potentially severe injury or illness, diagnosis, the use of diagnostic tests to identify clinical pathology, and subsequent care. Indicators such as fractures, dislocations, cancer, metabolic issues, infections, and other medical conditions are all taken into consideration.


History Taking and Physical Examination for Ankle and Foot Disorders

Conducting a physical examination and gathering medical history establishes the foundation for and guides the course of diagnostic and therapeutic measures. In instances where the results from clinical assessments differ from those obtained through other diagnostic methods, priority should be given to the objective clinical findings. The following details should be accurately documented in the medical records:


History of Present Injury for Ankle and Foot Disorders

The mechanism of injury, encompassing details about the onset and progression of symptoms, as well as any symptoms arising from postural or functional adjustments due to the ankle-foot injury;

Work-relatedness: A statement regarding the likelihood of the ailment or injury being related to work;

Previous injuries, both work-related and non-occupational, affecting the same area, along with any prior specialized treatments;

Functional capacity for performing daily activities and occupational tasks;

Factors that worsen or alleviate symptoms, considering not only the ankle-foot but also other relevant aspects.


Past History for Ankle and Foot Disorders

Past medical history may encompass conditions such as diabetes, gout, arthritis, and neoplasms.

Review of systems should consider symptoms related to rheumatologic, neurologic, endocrine, neoplastic, and other systemic disorders, not limited to those exclusive to the musculoskeletal system.

History of tobacco use in the past;
Details about career and leisure activities;
Documentation of any previous imaging studies;
Record of prior surgical interventions.


Physical Examination for Ankle and Foot Disorders

A joint examination should cover both the upper and lower aspects, as well as the opposite side for comparison. The physical examination should utilize procedures and tests tailored to the joint or area under assessment, such as:

  1. Visual Inspection: Look for asymmetries and abnormalities that may indicate degeneration, malformation, fracture, or dislocation. Examine both feet, checking for significant wounds like crush wounds, degloving injuries, lacerations, puncture wounds, and open wounds.
  2. Palpation:
  3. Quality and Range of Motion (Active and Passive): Assess the active and passive range of motion (ROM) in the foot and ankle. Compare mobility on the affected side with the unaffected side.
  4. Strength vs. Atrophy or Weakness:
  5. Joint Stability and Integrity: Stress the ligaments to determine stability and compare with the unaffected side.
  6. Deformity/Displacement Check: Examine for any deformities or displacement.
  7. Neurologic Evaluation: Assess motor, sensory, and reflex functions as clinically appropriate. Evaluate the vascular status, including the integrity of distal circulation, peripheral pulses, and skin temperature. Be vigilant for indicators of significant wounds, such as degloving, lacerations, puncture wounds, open wounds, and crush wounds.


Assessing Red Flags for Ankle and Foot Disorders

Certain findings, often referred to as “red flags,” indicate the potential presence of significant medical issues. During the review of history and physical examination, it’s essential to be alert to warning signs. In the foot and ankle, these signs may encompass compartment syndrome, fractures, dislocations, infections or inflammation, tumors, tendon ruptures, and infections or inflammation.

The New York Ankle and Foot Injury Medical Treatment Guidelines outline adjustments in clinical management prompted by the identification of “red flags.” In such cases, additional evaluation, consultation, or urgent/emergency action may be necessary.


Diagnostic Criteria and Differential Diagnosis for Ankle and Foot Disorders

In the majority of individuals with genuine foot and ankle conditions, diagnostic tests are usually unnecessary until after a period of conservative therapy and observation. Most ankle and foot problems tend to improve once any warning signs are addressed.

During the initial month of activity restriction, routine diagnostics, including lab tests, plain-film radiographs of the foot or ankle, or specialized imaging studies, are not recommended. Exceptions may be made if a history or examination finding raises suspicion of a significant foot or ankle problem or referred pain.


Diagnostic Testing and Procedures for Ankle and Foot Disorders

Choosing the appropriate diagnostic imaging procedure is crucial for ensuring accuracy, minimizing negative effects, and promoting cost-effectiveness. Different imaging methods offer varying levels of specificity and sensitivity for diagnoses, and none are exclusive to a particular condition. Clinical information gathered during history-taking and physical examination should guide the selection and interpretation of diagnostic procedures.

Repeating a diagnostic procedure is unnecessary if the initial procedure, along with clinical data, provides sufficient information for a proper diagnosis. However, if the first procedures are inconclusive, a subsequent diagnostic procedure, potentially a repeat of the same one, can be considered based on the professional’s judgment.

The choice of imaging technique depends on factors such as availability, patient tolerance, and the treating professional’s expertise. Repeat imaging exams may be necessary in some cases to monitor treatment effectiveness, reassess pathology, or post-operatively to monitor healing. It’s crucial to be mindful of the cumulative radiation dosage associated with repetitive CT exams and the associated risks.

Further evaluation of foot and ankle injuries may be needed based on the mechanism of injury, symptoms, and patient history when required.


What our office can do if you have workers compensation Ankle and Foot injury

We have the expertise to assist you with your workers’ compensation injuries. We comprehend the challenges you are facing and are committed to addressing your medical needs while adhering to the guidelines set by the New York State Workers Compensation Board.

Recognizing the significance of your workers’ compensation cases, we are here to guide you through the complexities of dealing with both the workers’ compensation insurance company and your employer.

We understand that this period can be stressful for you and your family. If you wish to schedule an appointment, please reach out to us, and we will make every effort to ensure the process is as smooth and convenient for you as possible.

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