High-Risk Foot


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

Pancreatic disease

  • Diabetic ketoacidosis  - A
  • Diabetes and severe vomiting - A
  • Acute severe hyperglycaemia
  • Acute severe hypoglycaemia - A
  • Hyperosmolar hyperglycaemic state (HHS) - A
  • Newly diagnosed type 1 diabetes – B (call registrar or consultant on call)
  • Foot ulcer with infection and systemically unwell or febrile -A
  • Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm) -A
  • Acute ischaemia - A
  • Wet gangrene - A

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, present to an emergency department.

High Risk Foot

  • 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
Useful Management Information
  • Refer to Healthpathways or local guidelines
  • For adults with diabetes, assess their risk of developing a diabetic foot problem 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 diabetic foot problem, continue to carry out annual foot assessments, emphasise the importance of foot care, and advise they could progress to moderate or high risk
  • Basic foot care advice and the importance of foot care
  • ATSI people with diabetes are considered to be at high risk of developing foot complications until adequately assessed otherwise
  • Commence antibiotics as per therapeutic guidelines  https://tgldcdp.tg.org.au/etgAccess
  • Off-loading https://www.sdc.qld.edu.au/courses/176 (This is a link to CSDC eLearning courses)
  • Advance health directive could be considered in patients with vascular disease https://www.qld.gov.au/law/legal-mediation-and-justice-of-the-peace/power-of-attorney-and-making-decisions-for-others/advance-health-directive/
  • Renal impairment increases the risk of amputation for people with diabetes who experience amputation rates 11 times that of the general diabetic population, which in turn is 15 times the rate in people without diabetes

Examine both feet for evidence of the following risk factors:

  • Neuropathy (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
  • Deformity
  • Gangrene
  • Charcot arthropathy
Minimum Referral Criteria

Does your patient meet the 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, at West Moreton please refer to high risk foot clinic, 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)
  • Diabetic with high-risk foot*
  • Peripheral arterial disease, peripheral neuropathy or foot deformity in the absence of adequate community resources

*High-risk foot has 2 or more of the following:

  • Peripheral Neuropathy (PN),
  • Peripheral Arterial Disease (PAD),
  • Foot deformity

or a history of:

  • previous amputation or
  • previous foot ulceration
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

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


Standard Referral Information

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

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, BMI), 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

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

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

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

Without this information the referral will be returned

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

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.


To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.