Podiatry  |  Elective Services


Elective Services

Referral Criteria

Ministry of Health criteria for podiatry referral for people with diabetes related foot complications

At risk foot (criteria for referral to communitybased podiatry services) High risk foot (criteria for referral to secondary care-based podiatry services)
  • A positive history of diabetic foot ulceration (and no current ulceration)
  • Neuropathic foot with absence of protective sensation (patient cannot detect the 10 g monofilament at four or more testing sites)
  • Biothesiometer threshold >25 V
  • Change to circulation and/or sensation with other risk factors present (see below) Neuropathy, musculoskeletal deformity and pre-ulcerative lesion


Risk factors:

  • Long standing diabetes
  • Elevated HbA1c
  • Nephropathy
  • Visual impairment
  • Poor glycaemic control
  • Hypertension
  • Smoking
  • Dyslipidaemia
  • Obesity
  • Impaired mobility
  • Social isolation
  • Perception of risk
  • Male> 40 years
  • Past history of gangrene or amputation
  • Peripheral vascular disease including:
    • Absent pedal pulses and a history of claudication
    • Ankle brachial index at 0.5–0.8 (indicating impaired arterial flow)
    • Night pain
    • Pre-ulcerated or ulcerated ischaemic lesion

URGENT referral to secondary care

  • Neuropathic or neuro-ischaemic ulcers that have not demonstrated significant measurable improvement (30–40%) within four weeks of treatment
  • Ulcers presenting at > Grade 2 or indolent Grade 1 (graded by podiatrist)
  • Cellulitis
  • Systemic signs of infection
  • Infection not responding to oral antibiotic therapy
  • Radiological or clinical evidence of bone involvement including active Charcot’s neuroarthropathy



Screening and Management of “The Diabetic Foot”

Last updated : Friday, October 06, 2017
Next review date : Saturday, October 06,2018

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.