High-risk foot (Diabetes and Endocrinology)
Adult

Podiatry

On this page

Emergency Referrals

Useful Management Information

For adults with diabetes, assess their risk of developing a diabetes-related foot disease at the following times:
- when diabetes is diagnosed, and at least annually thereafter
- if any foot problems arise
- on any admission to hospital, and if there is any change in their status while they are in hospital
For low risk of developing a diabetes-related foot disease, continue to carry out annual foot assessments, emphasise the importance of foot care, and advise they could progress to moderate or high risk, encourage review with podiatrist via Chronic Disease Management plan - Health professionals - Services Australia
Basic foot care advice and the importance of foot wear
Aboriginal and Torres Strait Islander people with diabetes are considered to be at high risk of developing foot complications until adequately assessed otherwise
Commence antibiotics as per therapeutic guidelines
Advance health directive could be considered in patients with vascular disease and end stage renal disease
Renal impairment increases the risk of amputation for people with diabetes who experience amputation rates 11 times that of the general population living with diabetes, which in turn is 15 times the rate in people without diabetes

Examine both feet for evidence of the following risk factors:

Loss of Protective sensation - LOPS (use a 10 g monofilament as part of a foot sensory examination)
Limb ischaemia (see CPC on peripheral arterial disease)
Ulceration
Callus
Infection and/or inflammation
Foot Deformity
Gangrene
Active / suspected Charcot arthropathy

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	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 Active or suspected acute Charcot foot Note: client to present to High Risk Foot Service / diabetes specialist service within 24 hours. If no specialist service is available, consult with a specialist service via telehealth e.g. Statewide Podiatry telehealth, Referral Statewide Community Foot Care Hub 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
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

Medical history, medications (recent Antibiotics) and allergies, foot disease history e.g. previous foot ulceration or amputation
Details of all treatments offered and efficacy
Peripheral pulses, femoral/popliteal/foot, including claudiaction distance, rest pain, ischaemic changes
Bone infection suspected

If a specific test result cannot 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

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?
Most recent HbA1c, renal function
Surgical history
Recent imaging e.g. X-Ray, MRI, Duplex
If suspected arterial disease, toe pressures, duplex scan etc

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

(E-Blueslips)

Fax

(07) 5687 4497

Post

Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

(07) 5687 4779

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Mr Manjeet Sagoo

Podiatry Lead

Facilities

Gold Coast University Hospital

Robina Hospital

Helensvale Community Health Centre

Robina Health Precinct

Tugun Satellite 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.

High-risk foot (Diabetes and Endocrinology)Adult