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.

  • acute arterial ischaemia/threatened limb
  • active infection +/- wet gangrene +/- foot ulceration with infection and systemically unwell or febrile, rapidly spreading cellulitis
  • systemic infection and foot ulceration with known diabetes

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

  • suspicion of acute Charcot neuroarthropathy (red, hot, swollen foot, +/- wound, +/- deformity)
  • infected foot ulceration with ≤ 2 cm erythema from wound edge
  • dry gangrene/necrosis +/- foot ulceration +/- diabetes
  • non infected/non healing wound ≥ 6 weeks +/-diabetes
  • review of patients with recent admission with known foot ulceration +/- infection +/- amputation +/- diabetes

Category 2 — appointment clinically indicated within 90 days

Diabetes with high-risk foot without ulceration. High risk includes any of the following:

  • peripheral neuropathy
  • peripheral arterial disease
  • foot deformity (including chronic Charcot neuroarthropathy)
  • haemodialysis or peritoneal dialysis dependent
  • identifies as Aboriginal or Torres Strait Islander

or a history of:

  • amputation
  • foot ulceration

Category 3 — appointment clinically indicated within 365 days

  • nil

For more on outpatient referrals, see the general referral information page.

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
  • SINBAD score
  • presence/absence pulses: dorsalis pedis/posterior tibial/popliteal
  • complete past medical history
  • current medication list
  • smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
  • body mass index (BMI)
  • haemodialysis or peritoneal dialysis dependent

Additional information to assist triage categorisation

  • X-ray-lateral/anteroposterior and weightbearing views (include location and accession number)
  • complete blood examination (CBE)
  • urea, electrolytes and creatinine (UEC)
  • liver function tests (LFT)
  • estimated glomerular filtration rate (eGFR)
  • glycated haemoglobin test (HbA1c)
  • Ankle Brachial Pressure Index
  • wound microscopy, culture and sensitivity (MCS) (infected wounds only)

SINBAD assessment tool

Assessment tool to obtain a SINBAD score
Category Definition Definition Score
Site Forefoot = 0 Mid/hindfoot = 1
Ischaemia Pedal blood flow intact - minimum one palpable pulse = 0 Clinical evidence of reduce pedal flow = 1
Neuropathy Intact protective sensation = 0 Lost protective sensation = 1
Bacterial Infection None = 0 Present = 1
Area Ulcer ≤ 1 cm2 = 0 Ulcer ≥ 1 cm2 = 1
Depth Ulcer confined to skin and subcutaneous tissue = 0 Ulcer reaching muscle, tendon or deeper = 1
Total

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Clinical management advice

Renal impairment increases the risk of amputation for people with diabetes. Amputation rates are:

  • 11 times higher in this cohort than those with diabetes alone
  • 15 times higher in this cohort than those without diabetes

Examine both feet for evidence of the following risk factors:

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

Clinical resources

Consumer resources