High Risk Foot and Podiatry Service - Royal North Shore

The Royal North Shore Hospital High Risk Foot and Podiatry Service (HRFS) uses a multi-disciplinary team approach to manage patients with complex lower limb pathologies due to a variety of medical presentations.

The main aim of the HRFS is to provide the best care possible for patients with high risk lower limb complications in order to prevent further lower limb ulceration, infection, hospital admissions and lower extremity amputations.

The HRFS provides care to patients admitted to hospital and within the outpatient setting.

• Blood Results
• Test results
• List of current medications
• Referral
• Medicare Card if you have one
• Any recent X-Rays of your lower limb
• Any recent pathology results
• Frequently worn footwear/orthotics 

If you have any of the following conditions, and live within any of the LGA’s serviced by Royal North Shore Hospital

• Active Foot/Leg Ulceration and/or managed Infection
• Active or Suspected Neuropathic Fracture (Charcot Neuro-arthropathy)

In the instance of a low-acuity non-complex presentation, the patient may be de-escalated to the Ryde Hospital Podiatry Service for ongoing review

Your GP or non-GP specialist is always your first step in seeking treatment for any condition. You will be referred to our service if your treating doctor feels that your treatment requires the input of a specialist. Once we receive the referral it will be reviewed by a doctor and you will be notified of the outcome and next steps. Please allow at least 4 weeks for this process to be undertaken. We see patients either face to face or via telehealth – our team will let you know what the best option is for you.
 
Please note that phone calls from the hospital will appear as a blocked number.
 
If you have a scheduled appointment you will receive a reminder text message.
 
Please allow a full morning or afternoon for your appointment. Some patients require a longer review and delays can occur.
 

Indications for urgent referral to local Emergency Department

• Suspected acute limb ischemia
• Suspected necrotising fasciitis 
• Lower limb wound with uncontrollable bleeding
• Lower limb complication with uncontrollable wound related pain
• Open fracture of the lower limb

To be eligible for our service, patients must meet one of more of the following criteria: 
 

High Risk Foot

• Active Lower Limb Ulceration 
• Active or Suspected Lower Limb Infection 
• Suspected or Confirmed Charcot Neuroarthropathy 
• Critical Limb Ischemia 

Podiatry

• Lower Limb Neuropathy 
• Lower Limb Vascular Disease 
• Inflammatory Arthropathy 
• Diabetes 
• Aboriginal and Torres Strait Islander People 
• End Stage Renal Disease or Renal Transplant Recipient 
• Previous Foot Ulcer 
• Previous Lower Limb Minor/Major Amputation
• Inactive Charcot Neuroarthropathy  

The HRFS liaises closely with other medical departments including:

• Vascular
• Orthopaedics
• Infectious Disease
• Renal
• Endocrinology
• Allied Health: Orthotics, Physiotherapy, Occupational Therapy
• Wound Clinical Nurse Consultants and Community Nurses

Podiatrists within the RNSH High Risk Foot Service provide a high level lower limb wound care to patients within the acute inpatient setting including but not limited to, the emergency department, severe state-wide burns unit, and intensive care. This involves the assessment, diagnosis and management a wide spectra of high acuity lower limb complications including complex leg and foot ulcerations of varying aetiologies, cellulitis, osteomyelitis and pressure injuries.

Podiatrists within the service possess an advanced knowledge and skills related to lower limb vascular assessment and foot/leg ulceration management, oedema management as well as experience pulsed jet lavage, ultrasonic and larval wound debridement therapy.
 

Please note, all referrals are screened, triaged and assigned a category of urgency depending on the reason for referral.

Please submit referrals using the eReferral system through HealthLink, which can be accessed through most clinical software systems. You can send a referral letter via fax or email to: 9463 1065 Or NSLHD-AccReferrals@health.nsw.gov.au (cc in or  NSLHD-RNSH-HighRiskFoot@health.nsw.gov.au if urgent)

Post a referral letter to: Podiatry and High Risk Foot Service Royal North Shore Hospital Ambulatory Care Centre, Level 3, Royal North Shore Hospital, Reserve Road, St  Leonards, 2065, Sydney, NSW, Australia

Referrals will be triaged and your patient will be notified of the outcome as soon as possible. This process may take between 1-4 weeks. You will be contacted if more information is needed.  

Telehealth services are available, please indicate on the referral if you feel this would be suitable for your patient’s appointment.

High Risk Foot Service Directory (NSW): https://aci.health.nsw.gov.au/resources/endocrine/service-directory/high-risk-foot

International Working Group on the Diabetic Foot Guidelines: https://iwgdfguidelines.org/guidelines-2023/