Podiatry  |  Elective Services




Podiatry

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 community based 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

     

  

 

 

 

 

 

 

 

The BOPDHB podiatrists provide support for those patients who do not meet the criteria for the PHO podiatry service. Services are for patients with high-risk feet i.e. with the following conditions:

  • Diabetes
  • Peripheral arterial disease
  • Patients on steroid or immunosuppressant therapy
  • Rheumatoid arthritis
  • Bony deformities
  • Connective tissue disorders
  • Symptomatic dermatological discorders eg; epidermolysis bullosa
  • Neuropathy
  • History of amputation
  • Chronic kidney disease stage 4 or 5


Past history of high risk foot referral:

    • Past history of gangrene and/or amputation: biomedical examination will be performed, referral for custom footwear, on-going treatment for callus/corns/areas of potential ulceration
        • Peripheral arterial disease including:
          • Absent pedal pulses, history of claudication, rest pain, pre-ulcerated or ulcerated ischaemic lesions
          • Dopplers and ABPIs will be performed and referral to vascular team as required for further investigation

 

Criteria for Urgent referral:

  • Non healing neuropathic or neuro-ischaemic ulcers within 4 weeks
  • Cellulitis requiring localised debridement that does not require acute admission

 

Criteria for Urgent admission:

  • Systemic signs of infection
  • Infection not responding to antibiotic therapy
  • Radiological or clinical evidence of bone involvement including active Charcot's neuroarthropathy

 

In contrast, PHO services include basic nail and skin care for patients without active ulceration who are at risk due to diabetic neuropathy and/or poor vision or mobility.

 


Screening and Management of “The Diabetic Foot”

 



Last updated : Friday, May 24, 2019
Next review date : Saturday, May 23,2020


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.