Foot and ankle conditions associated with diabetic foot disease
Adult

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

The list below includes common traumatic injuries that require referral to emergency and should not be referred for elective / fracture clinic categorisation.

Shoulder and elbow conditions

Clinically indicated e.g. suspected septic arthritis
- Evidence of acute inflammation e.g., haemarthrosis, tense effusion
Irreducible glenohumeral dislocation with or without fracture
Upper limb vascular compromise
Dislocation with or without fracture
Trauma with acute neurological or vascualar compromise

Wrist and hand

Uncontrolled sepsis including hand infections
Upper limb radiculopathy in the presence of suspected cervical spine infection
Acute development of peripheral nerve compression symptoms following trauma or acute event
Suspected flexor sheath infection
Suspected septic arthritis
Suspected malignancy

Hand trauma

Acute ligament injury
Tendon rupture
open ‘tooth knuckle’ injury

Hip and knee

Suspected septic arthritis
Acute extensor mechanism rupture
Fracture
Evidence of acute inflammation for example
- haemarthrosis
- tense effusion
Suspected infection or sudden pain in arthroplasty
If joint infection is suspected refer immediately to emergency or contact the orthopaedic registrar on call
- do not commence antibiotics unless delay to specialist review is likely

Foot and ankle

Suspected septic arthritis
Acute Achilles tendon rupture (if no fracture clinic available)
Avulsion fracture of Achilles tendon from calcaneus
Displaced fracture of the ankle or hindfoot
Infected diabetic ulceration (systemic signs/symptoms)

Trauma and fractures

Acute cervical myelopathy
Acute back or neck pain secondary to neoplastic disease or infection
Spinal injuries
Suspected open fracture
Fracture requiring manipulation or operation
Suspected acute bone or joint infection
Acute high energy fracture with/without neurological abnormality
Injury associated with vascular compromise
Clavicle fracture
Osteoporotic / pathological fracture new abnormal neurology
Joint dislocations
Open injuries with possible tendon or joint involved
Nail bed injuries or retained foreign body
Knee extensor mechanism rupture
Acute peripheral nerve injury
Suspected acute compartment syndrome

Back Pain

Cauda equina syndrome
High energy spinal trauma
Suspected epidural abscess or discitis

Upper and lower limb trauma

Open, unstable or suspected fractures

Timing of first review appointments at orthopaedic outpatient’s/fracture clinic

if there is documentation indicating adequate alignment and satisfactory initial treatment of fracture – to be seen within 14 days of referral
all other fracture cases, delayed presentation of tendon and nerve injuries - to be seen within 7 days of referral

Useful Management Information

Refer to Diabetic and Endocrinology High Risk Foot CPC
Patients with BMI >40 may be deemed unsuitable for surgery due to increased complication rate
Adequate chronic disease/lifestyle (SNAP ) management is a requirement for most surgical procedures
Optimal blood sugar control is strongly associated with better outcomes for all conditions of the foot and ankle
Smokers are not suitable for surgery of non-urgent foot and ankle conditions

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Acute ulceration or skin assessed as being at risk of ulceration Any fracture of the foot or ankle Acute redness, swelling or warmth with or without history of trauma with intact skin Radiological findings consistent with Charcot Foot Osteomyelitis
Category 2 (appointment within 90 calendar days)	Condition causing pain and/or dysfunction interfering with employment not amenable to attempts at non-operative management Concern regarding skin integrity due to foot deformity Nail related pathology causing infection or ulceration
Category 3 (appointment within 365 calendar days)	Persistent pain and/or dysfunction interfering with activities of daily living or recreational pursuits not amenable to attempts at non-operative management Nail pathology not associated with infection or ulceration
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

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), 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

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

History including pain assessment, impact on function including employment if applicable
History of ulceration
History of injury or trauma
Neurovascular examination findings
Plain X-ray, preferably weight bearing if able
MRI/CT not required but negates other imaging if obtained
Recent HbA1C

Additional Referral Information

Management to date (including podiatry/footwear modifications
Consider ultrasound if Plain X-ray normal

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Orthopaedics qhRefer

Fax

(07) 5687 4497

Post

Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Will Talbot

Medical Director Orthopaedics

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Foot and ankle conditions associated with diabetic foot diseaseAdult