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Southern Adelaide Local Health Network (SALHN)

Diabetes Foot Care Pathway

SA Health

Active Foot Disease Pathway

Diabetes Foot Care Pathway
Southern Adelaide Local Health Network (SALHN) 

Aboriginal and Torres Strait Islander peoples are recognised as a high risk group for foot ulceration and amputation. Aboriginal Health 
Workers/Practitioners are part of our HRFS to provide holistic and culturally safe care. 

Chronic Limb 
threatening
Ischaemia

Acute Limb 
Ischaemia

Charcot Foot

Foot Ulcer

Same day referral to SALHN HRFS for 
wound care and o?oading (pressure 
management)

Refer to Practice Points overleaf to 
implement  standard of care

Initiate appropriate antibiotic therapy and 
collection of microbiology specimens

For any queries please call the High Risk
Foot Co-Ordinator on: 0403 937 758

Severe infection
Foot infection associated with 
systemic  features (SIRS)

Clinical signs of in?ammation (redness,  
heat, swelling) present in the neuropathic 

foot. Pain may be present despite  
neuropathy. No evidence of a portal of  
entry (i.e. ulcer) to suggest infection.

Sudden Acute Foot Pain, Pallor or
coldness present over hours or days and
non-palpable foot pulses

Refer immediately to FMC ED

Same day referral to a vascular 
specialist or call the Vascular Registrar
at FMC via switch: Ph: (08) 8204 5511

PAD with either:
Pain on rest
Gangrene
Lower-limb ulceration

Infection present without systemic signs  or 
symptoms

Mild infection - &lt;2cm erythema periwound
involving skin &amp; subcutaneous tissue

Moderate infection - &gt;2cm erythema 
periwound involving deeper 

structures  
(i.e. tendon/bone)

Ulcer deep to tendon/joint/bone

Refer immediately to FMC ED

Action PlanPresentation

Active Foot
Disease

No infection in a super?cial ulcer

Same day referral to SALHN HRFS

Refer to O?oading in Practice Points 
overleaf to  implement standard of 
care.

Southern Adelaide Local Health Network High Risk Foot Service 
High Risk Foot Coordinator Ph: 0403 937 758 (Mon to Fri 0830   1630) After hours refer to FMC ED
Send all referrals to Podiatry Department: Ph: 8204 4884 Fax: (08) 8204 5020 email: Health.SALHNPodiatry@sa.gov.au

If not greater than 50% reduction by 2-4 
weeks, refer to SALHN HRFS
Refer to Practice Points overleaf to 
implement  standard of care.

Aboriginal and Torres Strait Islander peoples are recognised as a high risk group for foot ulceration and amputation.  
Aboriginal Health Workers/Practitioners are part of our HRFS to provide holistic and culturally safe care.

Active Foot Disease Pathway

Southern Adelaide Local Health Network High Risk Foot Service
High Risk Foot Coordinator Ph: 0403 937 758 (Mon to Fri 0830   1630) After hours refer to FMC ED
Send all referrals to Podiatry Department: Ph: 8204 4884 Fax: (08) 8204 5020 email: Health.SALHNPodiatry@sa.gov.au



Southern Adelaide Local Health Network (SALHN)

Diabetes Foot Care Pathway
Active Foot Disease Pathway

Southern Adelaide Local Health Network High Risk Foot Service
High Risk Foot Coordinator Ph: 0403 937 758 (Mon to Fri 0830   1630) After hours refer to FMC ED
Send all referrals to Podiatry Department: Ph: 8204 4884 Fax: (08) 8204 5020 email: Health.SALHNPodiatry@sa.gov.au

SA Health

Active Foot Disease Pathway

ED: Emergency department
FMC: Flinders Medical Centre
NH: Noarlunga Hospital 
HRFS: High Risk Foot Service
LOPS: Loss of Protective Sensation

PAD: Peripheral Artery Disease

SINBAD: Site (Ulcer), Ischaemia,
Neuropathy (LOPS), Bacterial infection,
Area, Depth
SIRS: Systemic In?ammatory Response 
Syndrome (refer to local guidelines)

High Risk Foot Service: The SALHN High Risk Foot Service comprises of clinics at 
multiple sites to provide best practice care. These include, FMC, NH and Marion GP Plus.

Clinics include: 

 The interdisciplinary foot clinic   consisting of Podiatry, Vascular Surgery,
Endocrinology, Infectious Diseases, Orthopaedic Surgery, Dietetics, Orthotics and
Prosthetics, Aboriginal Health, Medical Illustration, Diabetes Nurse Educator.

  Podiatry/Orthopaedic clinic

  Nail surgery clinic

  Podiatry Outpatient clinics

Co-morbidities: The presence of one or more additional conditions  co-occurring with a 
primary disease. While many people with  diabetes + foot infection may not require 
hospitalisation,  comorbidities, such as renal failure or an immunocompromised  state, 
may require an admission.

International Working Group Diabetic Foot Guidelines   2019: https://iwgdfguidelines.org/guidelines/guidelines/

Identi?cation and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 

Diabetes) 2011. Melbourne Australia  Diabetic foot problems: prevention and management NICE guideline (NG19): 

https://www.nice.org.uk/guidance/NG19

D-Foot International fast track pathway: https://d-foot.org/projects/fast-track-pathway-for-diabetic-foot-ulceration

NADC Collaborative Interdisciplinary Diabetes HRFS Standards 2018: https://nadc.net.au/wp-

content/uploads/2019/07/HRFS-Standards-FINAL-9.7.18.pdf

O?oading the ulcer or charcot
foot, consider immobilising the  

a?ected leg with knee-high  
cast/boot and/or wound care.

Discuss options with local HRFS

Address infection if present

Score ulcer (use SINBAD  plus 
other classi?cation system

as appropriate) to assess  
progress and facilitate faster  triage

Local wound care: sharp  
debridement and ulcer dressing  to 

absorb exudate

Optimise perfusion, diabetes 
holistic management and  

modi?able risk factors

Practice Points

Diabetes Foot Care Pathway
Southern Adelaide Local Health Network (SALHN) 

References

Southern Adelaide Local Health Network High Risk Foot Service 
High Risk Foot Coordinator Ph: 0403 937 758 (Mon to Fri 0830 - 1630) - after hours refer to FMC ED
Send all referrals to Podiatry Department: Ph: 8204 4884 Fax: (08) 8204 5020 email:Health.SALHNPodiatry@sa.gov.au

Definitions

Abbreviations


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