Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • pain following trauma where fracture is suspected
  • suspected acute bone or joint infection
    Note: do not commence antibiotics until reviewed by specialist medical officer – contact on-call registrar to discuss clinical concerns
  • suspected acute Charcot foot (where a High Risk Foot Service is not available) characterised by clinical signs of unilateral inflammation (redness, heat, swelling) present in the neuropathic foot, palpable pedal pulses, pain may be present despite neuropathy, no evidence of trauma, injury or ulcer to support infection.

When public outpatient services are not routinely provided

  • Clinical symptoms not severe enough to require surgical opinion for intervention.
  • Cosmetic foot surgery.
  • Diabetic Charcot foot.
    Note: consider referral to a High Risk Foot Service.
  • Osteoarthritis where non-operative management has not been undertaken.
  • Patient already on surgical waitlist in another local health district for the same condition.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Skin ulceration secondary to deformity or pressure.
  • Acute collapse with symptoms associated with avascular necrosis or Charcot neuropathy (for example clinical signs of unilateral inflammation).
  • Severe bilateral joint disease.
  • Severe difficulty in completing activities of daily living.
  • Unexplained, severe ankle pain (for example possible malignancy, impending fracture).
  • Patient highly likely to present to an emergency department due to challenges with activities of daily living.

Category 2
Recommended to be seen within 90 calendar days.

  • Non-acute ankle collapse associated with avascular necrosis, Charcot neuropathy or inflammatory arthritis.
  • Rapid decline in function of ankle and foot.
  • Persistent moderate ankle pain with gait disturbance that persists despite optimal non-surgical management (for example after 6 months of demonstrated supported exercise regime and weight loss attempt if indicated).
  • Inability to wear shoes.

Note: Patients are strongly encouraged to have undertaken a trial of non-operative management (for example podiatry and physiotherapy, optimisation of health co-morbidities) prior to referral

Category 3
Recommended to be seen within 365 calendar days.

  • Stable osteoarthritis of foot and ankle with compensated function.
  • Forefoot deformities with associated pain and/or osteoarthritis (for example bunions, claw toes).

Note: Patients are expected to have undertaken a trial of non-operative management (for example podiatry and physiotherapy, optimisation of health co-morbidities) prior to referral

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition, including symptoms and their duration, severity, location of pain and impact on function.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions).

If available

  • Management to date (including use of immobilisation, splint or cast, corticosteroid injections, orthotics or insoles, podiatry or physiotherapy management).
  • Previous surgery.
  • Evidence of significant impact on foot and ankle function, including mobility and falls risk.
  • Degree of interference with activities of daily living, walking tolerance and working ability.
  • Pain assessment (for example waking up at night, rest pain, analgesic consumption, aggravating and relieving factors).
  • Functional range of motion.
  • Relevant pathology (for example Hb1Ac, albumin levels).
  • X-ray: ankle and foot – bilateral anterior to posterior (AP), lateral and oblique views (weight bearing).
  • Medical (including vascular) and/or allied health reports.
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ or among a vulnerable, disadvantaged or priority population.
  • If the patient is willing to have surgery (where clinically relevant).
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Monday 17 June 2024
Contact page owner: System Purchasing