Foot and ankle conditions associated with diabetic foot disease

Emergency department referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

  • Royal Brisbane and Women's Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000
  • Redcliffe Hospital (07) 3883 7777
  • Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Suspected septic arthritis
  • Infected diabetic ulceration (systemic signs/symptoms)
  • Displaced fracture of the ankle or hindfoot

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • 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 days is desirable

  • 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 days is desirable

  • 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 your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • 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

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways or local guidelines
  • 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

Referral requirements

A referral may be rejected without the following 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 (useful for processing the referral)

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

Out of catchment

Metro North 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 North 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.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • 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
  • 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
  • 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
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • 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.)
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