Borders Ref Help Toolkit
Who to refer:
Refer urgently:
- Active Foot Ulceration
- Charcot Neuroarthropthy
- Foot infection which has required antibiotic treatment (excluding fungal nails)
- In-growing toenails/paronychia/painful curved nails with inflammation or infection
- Suspected posterior tibial tendon dysfunction (PTTD)
- Suspected Achilles Tendon rupture
Routine referrals:
Please provide as much detail as possible to help the triage process, including if patient is off work/study due to an foot and ankle condition, or is a main carer where a foot and ankle condition is impacting significantly on ability to provide care. Decision of priority remains with triaging clinician.
- Onychocryptosis without inflammation/infection
- Soft tissue pathology which is at future risk of ulceration
- Diabetic patients with a high risk/in remission status who require access to the service but do not have a current ulceration or are not currently at risk of breakdown
- Patients with diabetes whose risk factor has changed from low to moderate risk (this may be a one-off appointment)
- MSK conditions such as suspected Morton’s neuroma, plantar heel pain, tendinopathy, hallux valgus
- Non-specific MSK conditions i.e. general foot pain
- Soft tissue injuries
- Symptomatic nail or skin pathology which has not responded with self-management (not including fungal nails)
Please provide as much detail as possible to help the triage process.
What not to refer:
- Basic personal foot care and nail cutting
- Asymptomatic nail pathology in healthy individuals
- Fungal nail infections, including taking clippings for confirmation of fungal infection – if lab confirmation is wanted provide patient with sample envelop and advise to take clipping from as far back as possible to increase chance of accurate lab result (note that false negative can occur in up to 30% of sample cases (NICE, 2023)).
- Fungal infection of the skin
- Asymptomatic skin lesions such as callous and corns in healthy individuals
- Asymptomatic flat feet
- Osteoarthritis of the hindfoot, midfoot or forefoot (please refer to orthotics)
- Verrucae
- Requests for foot or ankle orthotics and bespoke footwear – these requests should be directed to the orthotics service. This includes ankle braces, splints, callipers.
Please note that NHS podiatry does not provide a nail cutting service, this includes for individuals who are unable to reach their feet but have no medical need for nail care from NHS podiatry. NHS Borders podiatry considers medical need to be the following:
- Neuropathy
- Peripheral Vascular Disease
- Rheumatology/inflammatory/autoimmune conditions
- Diabetes (moderate or high foot risk classification)
- Foot ulcers (Diabetic foot ulcers are referred straight to the Diabetic Foot Clinic)
- Neurological Disorders e.g. MS
- Undergoing chemotherapy or on dialysis
- Non traumatic foot/leg amputation (foot and ankle amputation caused by a medical condition)