Overview for NSW injured workers
Start with the dispute, not just the diagnosis
May be relevant when
Benefits to check
Legal help is useful when
How this affects your claim in practice
In a foot fracture claim, the diagnosis is only the starting point. The records should connect weight-bearing X-rays, CT or MRI identifying the bone, joint surface, displacement and healed alignment and operation records for fixation, fusion or repair of a Lisfranc or other complex injury with the worker's practical limits, including walking distance, push-off, uneven surfaces, ladders, prolonged standing and required footwear and whether loading and carrying duties can be performed with the healed foot structure. If the insurer disputes which fracture and joint remain responsible for symptoms, the response should address that reason directly.
Assessment source
- NSW Guidelines for the Evaluation of Permanent Impairment, paras 1.8-1.12: NSW Guidelines control the assessment method and AMA5 is used only where adopted and not modified.
- NSW Guidelines para 1.12: AMA5 Chapter 18 pain is excluded; chronic pain is assessed through the underlying diagnosed condition, while CRPS is assessed under the relevant NSW method.
- NSW Guidelines para 1.15: assessment should usually wait until maximum medical improvement, meaning the condition is stable and unlikely to change substantially in the next year.
- NSW Guidelines Chapter 3 applies AMA5 Chapter 17 only as modified by NSW. Paragraphs 3.2-3.7 require the most specific valid method, selection of the highest valid evaluation where more than one method applies, common units before combination, and a 40% WPI lower-limb maximum.
- NSW Guidelines para 1.24: activities of daily living must not be used to increase or reduce a calculated lower-extremity impairment. Functional examples explain the measurement; they are not an extra percentage.
- NSW Guidelines paras 3.8-3.15 and corrected AMA5 Tables 17-4 and 17-6: true leg length, gait, unilateral atrophy and manual muscle testing each have their own measurement and non-combination requirements.
- NSW Guidelines paras 3.16-3.18: inconsistent range-of-motion findings are invalid; values from different movement planes within one joint are added; joint ankylosis uses the corrected NSW optimum-position table and positional additions.
- NSW Guidelines paras 3.19-3.24: arthritis means radiological cartilage loss for impairment purposes. It cannot be assumed from pain, and the arthritis method cannot be combined with gait, atrophy, strength or range of motion.
- NSW Guidelines paras 3.10-3.15 and 3.32-3.35: gait is a last resort; gait, atrophy, muscle testing and peripheral-nerve methods can duplicate lower-limb function and must follow Table 17-2 non-combination rules; CRPS uses the NSW Chapter 17 method rather than AMA5 Chapter 18 pain.
- NSW Guidelines paras 3.26-3.30 and Tables 3.2-3.4: NSW modifies diagnosis-based estimates, tibial plateau fracture, patello-femoral and ankle replacement, tibia-os calcis angle and persistent plantar fasciitis. Hip and total-knee replacements use AMA5 Tables 17-33 to 17-35 subject to the NSW corrections.
What injuries or conditions may be assessed?
Foot fractures may affect a metatarsal, navicular, cuboid, cuneiform, talus, calcaneus or toe, or form part of a Lisfranc or other joint injury.
- The rateable consequence may be joint-surface damage, displacement, ankylosis, radiological cartilage loss, hindfoot malalignment, toe loss or another diagnosis-specific finding.
- The fracture name alone does not identify the method because forefoot, midfoot and hindfoot injuries affect different joints and functions.
Symptoms and findings that matter
Weight-bearing radiographs and, where clinically obtained, CT should identify the bone, joint involvement, displacement, union and alignment. Movement and fixed-joint findings must be recorded for the actual affected region.
For foot fracture, range of motion is normally measured three times in each relevant plane and the greatest valid result is used. If repeated readings or findings between examinations are materially inconsistent, ROM is not a valid impairment parameter.
If true leg length is relevant to foot fracture, manual measurement is an exception to the greatest-reading rule: three readings are averaged. The opposite joint or limb is also compared where it provides a valid baseline.
Where foot fracture is assessed through manual muscle weakness, the examiner uses the six Medical Research Council grades from 0 to 5. Those grades are ordinal rather than evenly spaced, and the NSW method uses AMA5 Table 17-8; electrodiagnostic results do not replace the manual muscle test.
An impairment report for foot fracture may need a diagnosis-based estimate, radiological cartilage-loss method, replacement score, true limb-length difference, unilateral atrophy, muscle grade, named-nerve deficit or gait method instead of, or in a limited case alongside, ROM.
What investigations are usually relevant
Investigations for foot fracture may include weight-bearing X-rays, CT, MRI, ultrasound or operation records identifying the actual joint, fracture, tendon, ligament, cartilage, prosthesis or nerve condition and repeat goniometer measurements, stability tests, alignment findings and comparison with the unaffected side where that comparison is valid. Each result should answer a defined clinical question and be read with the examination, diagnosis and history.
- Orthopaedic, rehabilitation and physiotherapy records showing whether the condition has reached maximum medical improvement.
- Certificates of capacity and duties evidence about walking, standing, stairs, kneeling, squatting, driving, lifting and uneven ground. These explain claim impact but do not alter the WPI calculation.
How WPI is assessed for this body part
For foot fracture, NSW Guidelines Chapter 3 applies AMA5 Chapter 17 subject to NSW corrections. The most specific valid method is used, and where more than one valid method applies the highest valid evaluation is generally selected unless Table 17-2 permits a combination.
If ROM is valid for foot fracture, values in different planes of the same joint are added. Regional values in the same limb are expressed in the same unit and combined before conversion to WPI.
For foot fracture, ankle dorsiflexion brings the toes towards the shin; plantarflexion points the foot down; inversion and eversion turn the sole inward and outward. Hindfoot alignment and true ankylosis use separate methods from ordinary movement loss.
Arthritis in an assessment of foot fracture requires radiologically measured cartilage loss. For a knee, only the most impaired compartment is used. Arthritis cannot be combined with gait, atrophy, strength or ROM for the same loss.
For foot fracture, gait remains a last-resort standalone method. Atrophy, manual muscle testing, peripheral nerve impairment and gait can duplicate strength loss and cannot be stacked. A diagnosis-based estimate is combined only where Table 17-2 permits it.
The calculation for foot fracture cannot be changed because of activities of daily living under NSW paragraph 1.24. Functional descriptions help explain the evidence but are not an uplift or deduction.
Table and value examples
Tibia-os calcis angle after hindfoot injury
110-100 degrees 5% WPI; 99-90 degrees 8% WPI; below 90 degrees increases by degree up to 15% WPIThis is a hindfoot alignment measure and should not be used for unrelated ankle pain.
Source: NSW Guidelines Table 3.4
Pantalar / triple / subtalar optimum ankylosis
19% / 6% / 4% WPIThe joint actually fixed determines the row; ordinary hindfoot stiffness is not ankylosis.
Source: NSW Guidelines Table 3.1
Worked assessment illustrations
These examples paraphrase the assessment reasoning in the source material. They explain method only and are not predicted outcomes.
Illustration 1
Foot fracture: selecting the anatomical method
Assumed facts: Assume a midfoot fracture has healed after fixation. Weight-bearing imaging identifies the joint affected and the examiner records stable movement and alignment findings.
Method: The assessor first identifies whether the valid result is a diagnosis-based fracture finding, ankylosis, radiological arthritis, hindfoot alignment or another permitted Chapter 17 method. The same loss is not rated again as gait or movement where combination is prohibited.
Illustrative outcome: No percentage is stated until the exact fracture, joint and table row are verified. This is a method illustration, not an outcome prediction.
Source: NSW Guidelines Chapter 3; AMA5 Chapter 17 as modified
What usually does not increase WPI
Fracture fixation, persistent foot pain or difficulty wearing work boots does not supply a percentage without the required anatomical and clinical findings.
Pain, tenderness, swelling or difficulty walking does not create a percentage without a valid lower-limb method.
A scan label, surgery name or recommendation for surgery is not a fixed WPI result.
Work restrictions, weekly payments and inability to resume the pre-injury job are important claim issues but are not themselves impairment measurements.
Activities of daily living cannot be used to increase or reduce the calculated lower-extremity rating.
Evidence checklist
The records for foot fracture should include the accepted injury description, date and any insurer decision limiting the body part or diagnosis and imaging and operation reports, including the relevant side, level, compartment and procedure. They are most useful when the diagnosis, examination and practical restrictions are consistent.
- Repeat movement, stability, alignment, circumference, limb-length or neurological measurements required by the selected method.
- A calculation worksheet identifying the table, regional unit, permitted combinations, conversion and rounding.
How this injury commonly happens at work
Work-related foot fracture can arise through a falling object or crush causing metatarsal, navicular, cuboid, cuneiform or phalangeal fracture and a fall or twist producing Lisfranc, talar, calcaneal or other joint-involving injury. The chronology should identify the actual task or event and when symptoms or function changed.
Work-related foot fracture can arise through a vehicle, machinery or high-impact event causing multiple foot fractures. The chronology should record the actual task or event and the point at which symptoms or function changed.
Common insurer disputes
For foot fracture, an insurer may dispute which fracture and joint remain responsible for symptoms and whether union, displacement, arthritis, ankylosis or alignment supports the method claimed. The written decision should be answered with evidence directed to those reasons.
Further disputes about foot fracture may concern whether symptoms arise from the foot, ankle, nerve or referred spinal condition and whether a broad fracture diagnosis has been assigned a percentage without the required table criteria. The decision notice should identify which issue is relied on and the evidence said to support it.
Treatment and surgery issues
Depending on the diagnosis and treating opinion, management of foot fracture may involve fracture and weight-bearing progression, fixation follow-up, orthotics and rehabilitation where supported and specialist review for non-union, malalignment, arthritis or painful hardware where clinically justified. The request should explain the expected functional benefit and its connection to the accepted injury.
Weekly payments and work capacity
Capacity evidence for foot fracture should address walking distance, push-off, uneven surfaces, ladders, prolonged standing and required footwear and whether loading and carrying duties can be performed with the healed foot structure. Proposed duties must be sustainable for the proposed hours, not merely possible once.
For foot fracture, capacity evidence should address whether alternate duties reduce impact and permit medically required footwear or breaks. The question is whether those activities can be performed safely, reliably and for the proposed hours—not whether a task can be attempted once.
How NSW Work Injury Claim can help
For foot fracture, a claim review can help to identify the fracture and weight-bearing joint affected and compare healed imaging with movement, alignment and neurological findings. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
For foot fracture, a claim review can help to check method selection and conversion before relying on a WPI figure. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
Common questions about foot fracture claims
How can work cause or aggravate foot fracture?
For foot fracture, the relevant work history may include a falling object or crush causing metatarsal, navicular, cuboid, cuneiform or phalangeal fracture, a fall or twist producing Lisfranc, talar, calcaneal or other joint-involving injury, and a vehicle, machinery or high-impact event causing multiple foot fractures. A claim still depends on the actual chronology and medical evidence. The records should identify what changed, when symptoms began or worsened, and how the diagnosed condition affects the worker's duties.
How is WPI assessed for foot fracture?
For foot fracture, NSW Guidelines Chapter 3 applies AMA5 Chapter 17 subject to NSW corrections. The most specific valid method is used, and where more than one valid method applies the highest valid evaluation is generally selected unless Table 17-2 permits a combination. Weight-bearing radiographs and, where clinically obtained, CT should identify the bone, joint involvement, displacement, union and alignment. Movement and fixed-joint findings must be recorded for the actual affected region. The assessor must apply the NSW Guidelines to the accepted, stable condition; the diagnosis or an operation does not by itself determine a percentage.
Which records are most useful for a foot fracture assessment?
A foot fracture assessment commonly needs the accepted injury description, date and any insurer decision limiting the body part or diagnosis, imaging and operation reports, including the relevant side, level, compartment and procedure, repeat movement, stability, alignment, circumference, limb-length or neurological measurements required by the selected method, and a calculation worksheet identifying the table, regional unit, permitted combinations, conversion and rounding. Those records are most useful when they describe the same diagnosis, examination findings, treatment history and practical work restrictions.
What does an insurer commonly dispute about foot fracture?
For foot fracture, common issues include which fracture and joint remain responsible for symptoms, whether union, displacement, arthritis, ankylosis or alignment supports the method claimed, and whether symptoms arise from the foot, ankle, nerve or referred spinal condition. The response should address the insurer's stated reason with the relevant chronology, clinical findings, investigations and duties evidence rather than relying on the diagnosis alone.
How can foot fracture affect weekly payments and suitable duties?
Capacity evidence for foot fracture may need to address walking distance, push-off, uneven surfaces, ladders, prolonged standing and required footwear, whether loading and carrying duties can be performed with the healed foot structure, and whether alternate duties reduce impact and permit medically required footwear or breaks. A certificate should describe what the worker can do safely and sustainably. Proposed duties should then be checked against those restrictions and the real demands of the job.
Does foot fracture automatically receive a fixed WPI percentage?
No. For foot fracture, one verified example is tibia-os calcis angle after hindfoot injury: 110-100 degrees 5% WPI; 99-90 degrees 8% WPI; below 90 degrees increases by degree up to 15% WPI, under NSW Guidelines Table 3.4. That value applies only when its stated criteria are met. Fracture fixation, persistent foot pain or difficulty wearing work boots does not supply a percentage without the required anatomical and clinical findings.
Request a calm claim position review
If you have received an insurer decision or you are unsure how your injury evidence fits together, we can help you identify the issue, organise the documents and consider the next step. Where ILARS funding is approved, eligible legal costs and necessary disbursements may be covered.