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Minor toe procedures (Claw Toe, Hammer Toe, Ingrowing Toenail) – Information for GPs

Referral criteria / commissioning position

Secondary care surgical procedures are not routinely commissioned for these conditions; Requests for funding are required prior to referral to the Individual Funding Request Panel (IFR) on the grounds of clinical exceptionality; the minimum requirements are:

Referral may be consider (via the IFR panel) if:

  • primary care management has been unsuccessful in resolving the issue

AND

  • the patient suffers from severe pain on walking (not relieved by chronic standard analgesia)

OR

  • severe deformity (with or without lesser toe deformity) that causes significant functional impairment OR prevents them from finding adequate footwear

OR

  • recurrent or chronic ulceration or infection

Patients to be referred to local Podiatry services prior to referral to secondary care.

Treatment in all other circumstances is not normally funded and should not be referred unless there is prior approval by the IFR panel.

Investigations prior to referral

None

Information to include in referral letter

The GP referral letter should contain:

  • Description of symptoms and duration including reason for clinical
    exceptionality
  • Details of treatments and measures tried including outcomes
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

References and additional information

  1. E-medicine: Claw toe http://www.emedicine.com/orthoped/topic51.htm
  2. GP notebook.com http://www.gpnotebook.co.uk/simplepage.cfm?ID=382730244
  3. Royal College of Surgeons Commissioning Guide: Painful deformed great toe in adults (July 2017) can be found here.
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