Referral to emergency

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.

  • nil

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • flexible flat foot, i.e. if arch corrects when standing on tip toes or arch can be seen in a non-weight bearing position, without pain
  • child aged < 6 years with functional impairment, e.g. recurrent falls, as a result of flat foot. Note: consider referral to physiotherapy or paediatric podiatry, see ‘Clinical Management Advice’
  • child aged < 3 years, most children this age have flat feet
  • painful flat foot with morning stiffness, refer instead to Rheumatology

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • asymmetrical deformity
  • child aged ≥ 6 years with difficulty in activity/functional impairment as a result of flat foot
  • rigid flat foot, i.e. arch does not reform when standing on tip toes or in a non-weight bearing position
  • progressive deformity or lack of spontaneous resolution

Category 3 (appointment clinically indicated within 365 days)

  • symptomatic flat foot, e.g. painful flat foot/feet, localised tenderness, limp, stiffness. Note: if experiencing painful flat foot with morning stiffness refer to Rheumatology
  • ongoing concerns in a child aged < 6 years with functional impairment as a result of flat foot despite physiotherapy and parental reassurance

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • details of the presenting condition, including symptoms and their duration
  • clinical history
  • physical examination
  • for rigid flat foot only: weight-bearing x-ray — anterior-posterior (AP), lateral and oblique. Include provider, location and date of any imaging.

Additional information to assist triage categorisation

  • details of any foot asymmetry

Clinical management advice

  • Most children with a flexible flat foot do not require any treatment
  • it is normal for arch to develop by age 6
  • the vast majority of patients with flexible flat feet do not require an orthopaedic referral
  • orthotics do not help form an arch
  • no treatment is required for flexible flat foot, i.e. if arch corrects when standing on tip toes or arch can be seen in a non-weight bearing position

Referral requirements for specific sites

  • Physiotherapy at Women’s and Children’s Hospital (WCH) do not accept referrals from General Practitioners (GPs).
  • Physiotherapy at Lyell McEwin Hospital (LMH) do accept referrals from GPs for paediatric orthopaedic conditions.
  • Referrals to Southern Adelaide Local Health Network (SALHN) for Flat Feet can be made to Paediatric Podiatry.

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • 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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.