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High-risk foot (Diabetes and Endocrinology)


Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Refer directly to emergency - Foot ulcer with infection and systemically unwell or febrile, invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm), acute ischaemia, wet gangrene, acute or suspected Charcot - A
    • Foot ulcer or pressure injury with mild to moderate infection <2cm around wound. - B
    • Necrosis/dry gangrene (with or without ulceration) - B
    • 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

    Urgent cases – (refer to key below)
    A – client to present to emergency department immediately
    B – client to present to diabetes specialist service within 24 hours. If no specialist service is available, consult with a specialist service via telehealth, or present to an emergency department.

  • Category 2
    (appointment within 90 calendar days)
    • High Risk Foot (IWGDF Risk Stratification): Loss of protective sensation (LOPS) or Peripheral artery disease (PAD), and one or more of the following:
      • History of foot ulcer
      • A lower extremity amputation (minor or major)
      • End-stage renal disease
    • Peripheral arterial disease, peripheral neuropathy, or foot deformity in the absence of adequate community resources

  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Details of all treatments offered and efficacy
  • Peripheral pulses, femoral/popliteal/foot

3. Additional referral information Useful for processing the referral

  • Is the ulcer neuropathic or ischaemic (or both) in origin?
  • Is there active infection? Consider deep wound swab/pathology for culture, ESR, CRP, FBC
  • Is there invasive infection with spreading cellulitis around the wound?
  • Is there bony infection? XR if required.
  • If suspected arterial disease –Doppler Ankle Brachial Pressure Index (ABPI), toe pressures, duplex scan etc
  • Appropriate medical history including claudication distance, rest pain, ischaemic changes and risk factors
  • Results of depression screening (PHQ-2)
    • over the last 2 weeks, how often have you been bothered by any of the following problems?
      • little interest or pleasure in doing things?
      • feeling down, depressed, or hopeless?

4. Request

Last updated: 13 June 2023