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MSK Podiatry Triage and Self-Referral Form

The Musculoskeletal (MSK) Podiatry Service receives referrals for assessment, diagnosis and management of lower limb pain with a focus on the foot and ankle.

This self-referral form has been designed to ensure we can give you the most appropriate support.

Please complete all the questions fully as the more information we have about your symptoms, the better we are able to support you.

It takes approximately 15 minutes on average to complete this form.

Important Notice

DO NOT complete this form If you are seeking treatment for an acute foot, ankle or leg injury that has happened in the last few days. You should seek help from either:  

Minor Injuries (Telephone bookings only: 01443 444075 / 444060) or an Emergency Department

DO NOT complete this form but make an appointment to see your GP to discuss your referral if you have any of the following:

  • Have recently become unsteady on your feet.
  • Have recently developed swelling in your legs and feet.
  • Your foot, ankle or leg pain is constant 24 hours a day.
  • Have recently developed numbness, pins and needles or cramp in your legs or feet.

DO NOT continue with this form and instead make an appointment to see your GP if you:

  • Are under 16 unless you have already seen a health care professional for this problem.
  • Are unable to attend the Outpatient Department.
  • Are seeking treatment for a diagnosed neurological or a rheumatological condition.
  • Are seeking NHS treatment for toe nail cutting or reducing callus (hard skin).
Treating your foot problem yourself (Self-Management)

Evidence shows that most new injuries, aches, & pains will improve within 12 weeks with simple self-management. If your symptoms are less than 12 weeks' old, you may be able to improve your condition with simple advice and exercise.

BUNIONS

Bunions QR Code If your concern is Bunions (Hallux Abductovalgus) you can access self-management information by scanning the following QR code with your mobile smart phone here or alternatively use the web address link below:

Bunions - Keeping Me Well

We cannot accept referrals for bunions unless you have tried all self-management advice for 3 months and you are still in significant pain.

HEEL PAIN

Heel Pain QR Code If your concern is pain underneath the heel of your foot (plantar fasciitis) that is not caused by an acute injury, you can access self-management information by scanning the following QR code or alternatively use the web address link below:

Plantar Fasciopathy - Keeping Me Well

We cannot accept referrals for pain underneath the heel of your foot (plantar fasciitis) unless you have tried all self-management advice for 3 months (in line with community pathways guidelines) and you are still in significant pain.

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