This service is to diagnose and treat patients with 'at-risk' feet and lower limbs.

Eligibility Criteria

The PHO podiatrists provide support for those patients who:

1. Have diabetes; and 

2. Have any of:

• A history of lower limb ulcers or amputation within the last 2 years
• Peripheral neuropathy (including failed monofilament testing)
• Peripheral vascular disease; and

3. Require:

• Nail care (including ingrowing nails)
• Callus care
• Education

In contrast, DHB services are for patients with active foot disease (e.g. active ulceration or infection). The patients do not need to be diabetic. See the DHB eReferral for more information.

If your patient does not meet the community podiatry eligibility criteria, other sources of potential funding include:

• The Disability Allowance from Work and Income
• The Veterans' Support Act administered by the New Zealand Defence Force
• ACC
• Some Hauora clinics
  
  

Patients can also self-refer and pay privately.

Exclusion Criteria

The presence of active infection, such as:

• Infection/cellulitis
• Open wounds
• Current ulcers
• Absent pulses
• Rest pain
• Claudication
• Suspected Charcot joint 

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.