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 injury claim, the diagnosis is only the starting point. The records should connect x-ray, ultrasound or MRI and podiatry, orthopaedic or physiotherapy notes with the worker's practical limits, including standing, walking, stairs, kneeling, squatting, driving and load carrying and safe duties that avoid unsafe mobility demands. If the insurer disputes whether the injury is a sprain only, 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 injuries include calcaneal, talar, navicular, cuboid, cuneiform, metatarsal or toe fracture; Lisfranc injury; tendon or plantar fascia injury; joint instability and post-traumatic arthritis.
- Hindfoot injury may alter the tibia-os calcis angle or lead to subtalar, triple or pantalar ankylosis. Forefoot injury may affect weight transfer or toe function.
- The exact bone, joint and displacement must be identified because ordinary foot pain has no single WPI method.
Symptoms and findings that matter
Weight-bearing films, hindfoot alignment, displacement on both sides of the named joint, movement and any fixed joint determine whether a foot, lower-extremity or WPI table applies.
For foot injury, 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 injury, 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 injury 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 injury 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 injury 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 injury, 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 injury, 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 injury, 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 injury 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 injury, 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 injury 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
Persistent plantar fasciitis
2% lower extremity impairment or 1% WPIThis requires persistent symptoms and clinical findings after 18 months. It is not a rating for short-lived heel pain.
Source: NSW Guidelines para 3.28
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 injury: restricted ankle plantarflexion
Assumed facts: Assume a hindfoot or ankle component of the accepted foot injury leaves reproducible movement loss. Three valid readings are taken after the condition has stabilised. The greatest valid plantarflexion result is 8 degrees, and the opposite ankle does not require a baseline deduction.
Method: For this foot injury illustration, Eight degrees falls within the corrected moderate plantarflexion-capability row of 1-10 degrees in Table 17-11.
Illustrative outcome: This shows how the selected foot injury method is applied without an ADL adjustment. The moderate row is 6% WPI (15% LEI; 21% foot). If the readings were inconsistent, ROM would not be a valid method. This is an illustration only.
Source: NSW Guidelines paras 3.16-3.17 and corrected AMA5 Table 17-11; AMA5 Chapter 17 repeat-measurement method
What usually does not increase WPI
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 injury 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 injury can arise through slips, trips or uneven surfaces and jumping down from vehicles or platforms. The chronology should identify the actual task or event and when symptoms or function changed.
Work-related foot injury can arise through prolonged standing or walking and twisting on stairs or wet floors. The chronology should record the actual task or event and the point at which symptoms or function changed.
Common insurer disputes
For foot injury, an insurer may dispute whether the injury is a sprain only and whether ongoing symptoms reflect pre-existing changes. The written decision should be answered with evidence directed to those reasons.
Further disputes about foot injury may concern whether safe duties ignore standing or walking limits. 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 injury may involve boot, brace, physiotherapy, podiatry, injections or surgical review where supported. The request should explain the expected functional benefit and its connection to the accepted injury.
Weekly payments and work capacity
Capacity evidence for foot injury should address standing, walking, stairs, kneeling, squatting, driving and load carrying and safe duties that avoid unsafe mobility demands. Proposed duties must be sustainable for the proposed hours, not merely possible once.
For foot injury, capacity evidence should address travel to work and medication effects where relevant and weekly payment decisions where partial capacity is overstated. 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 injury, a claim review can help to clarify diagnosis and mechanism of injury and compare work duties with medical restrictions. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
For foot injury, a claim review can help to respond to treatment or work capacity disputes and prepare WPI evidence when the condition becomes stable. 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 injury claims
How can work cause or aggravate foot injury?
For foot injury, the relevant work history may include slips, trips or uneven surfaces, jumping down from vehicles or platforms, and prolonged standing or walking. 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 injury?
For foot injury, 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 films, hindfoot alignment, displacement on both sides of the named joint, movement and any fixed joint determine whether a foot, lower-extremity or WPI table applies. 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 injury assessment?
A foot injury 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 injury?
For foot injury, common issues include whether the injury is a sprain only, whether ongoing symptoms reflect pre-existing changes, and whether safe duties ignore standing or walking limits. 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 injury affect weekly payments and suitable duties?
Capacity evidence for foot injury may need to address standing, walking, stairs, kneeling, squatting, driving and load carrying, safe duties that avoid unsafe mobility demands, and travel to work and medication effects where relevant. 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 injury automatically receive a fixed WPI percentage?
No. For foot injury, 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. Pain, tenderness, swelling or difficulty walking does not create a percentage without a valid lower-limb method.
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.