Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • suspected acute bone or joint infection: do not commence antibiotics until reviewed by specialist medical officer, contact the on-call registrar to discuss clinical concerns
  • suspected acute Charcot foot characterised by:
    • clinical signs of unilateral inflammation (redness, heat, swelling) present in the diabetic neuropathic foot
    • palpable pedal pulses
    • pain may be present despite diabetic neuropathy
    • no evidence of trauma/injury/ulcer to support infection

I concerns of Charcot foot exist please contact the High-risk Foot coordinator to discuss, see ‘Contacts for clinical advice’.

For urgent referrals and/or clinical advice, please telephone the relevant metropolitan Local Health Network.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

  • High-risk Foot Coordinator  (9.00 am to 4.00 pm Monday to Friday) 0412 504 937
  • After hours medical enquiries should be directed to the Royal Adelaide Hospital (08) 7074 0000

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • nil

Category 2 — appointment clinically indicated within 90 days

  • avascular necrosis

Category 3 — appointment clinically indicated within 365 days

  • osteoarthritis of foot and ankle

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • complete past medical history
  • current medication list
  • body mass index (BMI)
  • previous surgery
  • private health cover/compensable status e.g. WorkCover claims
  • management history including:
    • injury/trauma if relevant
    • onset and duration
    • pain
    • associated features, e.g. swelling, instability
    • functional impairment
    • immobiliser/splint/cast
    • corticosteroid injections
  • functional range of motion (ROM)
  • X-ray anterior posterior and lateral ankle/foot including weight bearing/standing views, include radiological details/accession number

All patients with non-palpable pulses should be referred utilising the Vascular ‘High-risk Foot - Adult' CPC.

Additional information to assist triage categorisation

  • complete blood examination (CBE)
  • electrolytes, urea, creatinine (EUC)
  • liver function tests (LFTs)
  • estimated glomerular filtration rate (eGFR)
  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • uric acid
  • smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
  • alcohol and other drugs history including type, amount and frequency

Clinical management advice

Examine both feet for evidence of the following risk factors:

  • neuropathy
  • ulceration
  • callus
  • infection and/or inflammation
  • deformity
  • gangrene
  • Charcot neuroarthropathy
  • presence/absence pulses: dorsalis pedis/posterior tibial/popliteal.

Consideration of risks versus benefits of surgical intervention may include:

  • age
  • frailty
  • additional comorbidities
  • patient expectations of outcome
  • patient suitable for surgery, engagement in self-management
  • body mass index (BMI) and weight loss
  • smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation.

Optimisation of chronic medical conditions should occur as part of initial assessment and conservative management as this may impact on suitability for surgical intervention.

Patients with BMI ≥ 35 should be referred for weight loss management with or without bariatric opinion. Patients with BMI ≤ 40 may be considered for review with documented evidence of participation in attempts to lose weight.

Clinical resources

Consumer resources