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High Risk Foot

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

Examine both feet for evidence of the follow risk factors:

  • Neuropathy (use a 10g monofilament as part of a foot sensory examination)
  • Limb ischemia (see Peripheral arterial disease)
  • Ulceration
  • Callus
  • Infection and/or inflammation
  • Deformity
  • Gangrene
  • Charcot arthropathy

For adults with diabetes – find assessment and management information at Brisbane South HealthPathways under Diabetic Neuropathy

Further information:

Minimum referral criteria (Does your patient meet the minimum criteria?)

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark “urgent” on your referral

  • Foot ulcer or pressure injury with mild to moderate infection <2cm around wound*
  • Necrosis/dry gangrene (with or without ulceration) *
  • Non-infected foot ulcer.  For optimal care, a patient with an ulcer will be reviewed within 48 hours by a specialist High Risk Foot Service
  • suspected /acute Charcot foot

*client to present to High Risk Foot Service within 48 hours

Category 2
(appointment within 90 calendar days)
  • Patient with high-risk foot**
  • Loss of protective sensation Or Peripheral arterial disease and one or more of previous ulcer / lower limb amputation or end stage renal disease 
Category 3
(appointment within 365 calendar days)
  • No Category 3 criteria

**High-risk foot

  • Peripheral neuropathy (PN),or Peripheral Arterial Disease  (PAD)

And one or more of

  • Previous foot ulcer
  • Previous lower limb amputation
  • End stage renal disease

If your patient does not meet the minimum referral criteria:

  • Find assessment and management information at Brisbane South HealthPathways under
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

 

Essential referral information for High Risk Foot referrals (Referral will be returned without this)

  • Comorbidities and past medical history
  • Details of all treatments offered, and efficacy to date e.g. type of dressing used, date of commencement of any antibiotics with dose prescribed

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral

Additional referral information for High Risk Foot referrals

  • Relevant clinical history/vascular referrals including previous history of Charcot arthropathy
  • History of allergies and list of current medications
  • Current podiatry treatment/dressing regimen, toe pressures if available
  • Relevant pathology (as clinically indicated)
  • Recent vascular imaging (duplex studies, ABPI if already completed)
  • Relevant medical imaging results if available – i.e. x-ray, ultrasound
  • Clinical photograph – with patient’s consent, where secure image transfer, identification and storage is possible

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries.  Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 8 August 2024