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
If 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
- High-risk Foot Coordinator (9.00 am to 4.00 pm Monday to Friday) 0481 155 858
- Royal Adelaide Hospital (08) 7074 0000
- The Queen Elizabeth Hospital (08) 8222 6000
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
- red hot swollen foot in known diabetic; with suspicion of acute Charcot neuroarthropathy without ulceration with pedal pulses
Category 2 — appointment clinically indicated within 90 days
Category 3 — appointment clinically indicated within 365 days
- clawed toes/hammer toes
- flat feet
- functional impairment with or without pain unresponsive to maximal medical management
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
- identify within your referral 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)
- smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
- alcohol and other drugs history including type, amount and frequency
- previous surgery
- management history including:
- injury/trauma if relevant
- onset and duration
- associated features, e.g. swelling, instability
- functional impairment
- functional range of motion (ROM)
- X-ray results anterior posterior and lateral ankle/foot including weight bearing/standing views include radiological details/accession number
- relevant reports and investigations
- details of other practitioners involved in management
Clinical management advice
Examine both feet for evidence of the following risk factors:
- infection and/or inflammation
- Charcot neuroarthropathy
- presence/absence pulses: dorsalis pedis/posterior tibial/popliteal.
All patients with non-palpable pulses should be referred utilising the Vascular ‘High-risk Foot - Adult' CPC.
Consideration of risks versus benefits of surgical intervention may include:
- 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.
- HealthPathways SA - Foot Complications in Diabetes (log in required)
- HealthPathways SA - Frail But Stable Older Persons (log in required)
- Foot Forward
- International Working Group on the Diabetic Foot Classification of Diabetic Foot Ulcers (PDF 830KB)