The task
Assume that today's date is 22 October 2026. You saw Mr Kovalenko in your clinic this morning.
You are a podiatrist working at a community podiatry clinic. Using the information in the case notes, write a letter to Ms Liezl Mazur, Podiatrist at the Multidisciplinary High-Risk Foot Service, referring Mr Kovalenko for urgent triage (within one working day) and specialist assessment. Address the letter to Ms Liezl Mazur, Podiatrist, Multidisciplinary High-Risk Foot Service, Outpatient Clinic B, 45 Park Road. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
Case notes
Patient details
- Name: Mr Peng Kovalenko
- DOB: 14/03/1974 (52 yrs)
- Address: 7 Banksia Street
- Booked for routine 3-monthly high-risk foot review; seen today 22/10/26 with new problem
Social background
- Warehouse supervisor: on his feet most of 8-hr shift
- Lives with wife and 2 teenage children
- Drives to work (automatic car)
- Enjoys fishing at weekends
- Wife phoned clinic: says pt is 'too stubborn to ever rest' and 'only cares about work'
- Ex-smoker (quit 2015); alcohol 2–3 std drinks/wk
Medical history
- T1DM since age 14 (38 yrs); basal-bolus insulin; HbA1c 8.6% (09/26)
- Peripheral neuropathy: loss of protective sensation both feet (10 g monofilament)
- Diabetic retinopathy: laser treatment 2021, stable
- Microalbuminuria: on ramipril
- Appendicectomy 1995
- Allergies: penicillin (rash)
- L hallux neuropathic ulcer 2022: healed
Assessment 22/10/26
- C/O swelling R foot × 2/52; little or no pain; shoe feels tight
- Twisted R foot stepping off kerb ~3/52 ago; continued working
- R midfoot warm, red, swollen; skin intact; no ulcer or wound
- Skin temp (infrared thermometer): R midfoot 2.8°C ↑ than same site L foot
- Pedal pulses palpable bilat; CRT < 3 sec
- No obvious deformity; arch profile similar to L
- Afebrile (36.8°C); no lymphangitis; no calf tenderness
- Pt says GP 'brushed it off as a sprain' last wk; very unhappy with practice
Treatment/Progress
- Impression: suspected acute Charcot neuroarthropathy R midfoot
- Removable knee-high offloading walker boot fitted + crutches; advised to minimise weight bearing
- Advised: wear boot at all times (day and night) pending urgent specialist review; remove only for hygiene/skin checks, without bearing weight on R foot; check both feet daily for skin damage
- Advised not to drive while wearing boot on R foot
- To see GP re: time off work / medical certificate
- GP informed by phone today
Plan
- Urgent referral to MDT high-risk foot service sent today 22/10/26 → triage within 1 working day; then assessment, imaging (X-ray R foot; further imaging e.g. MRI if X-ray normal) and definitive immobilisation (e.g. total contact cast)
- Pt told: if skin breaks down or signs of infection → attend ED same day
- Phoned foot service today: referral discussed, urgent triage confirmed; if appt not confirmed by next working day → escalate via local urgent pathway
Who is reading, and what do they need?
Ms Mazur is a podiatrist in the specialist service who has not met the patient. She must triage within one working day, so she needs the diabetes and neuropathy background, the key findings, what has been done and what is planned. Keep detail focused and clinical, with no social or relational material.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| T1DM for 38 years, basal-bolus insulin, HbA1c 8.6% (09/26) | Establishes diabetes duration and current control, which the triage clinician needs to judge risk for this presentation. |
| Loss of protective sensation both feet on 10 g monofilament | Neuropathy is central to the suspected diagnosis and explains why little or no pain is reported despite the findings. |
| Swelling R foot for 2 weeks; little or no pain; shoe feels tight | Gives the presenting complaint and its duration, which the specialist needs to understand the time course. |
| Twisted R foot stepping off kerb about 3 weeks ago; continued working | Records the reported injury and continued activity as history only, without stating it as the cause. |
| R midfoot warm, red, swollen; skin intact; 2.8°C higher than left | Objective findings supporting the impression; intact skin and the measured temperature difference help prioritise triage. |
| Pulses palpable, afebrile, no lymphangitis, no calf tenderness, no obvious deformity | Relevant negatives show what was checked and help the reader weigh other possible explanations without excluding them. |
| Knee-high walker boot, crutches, boot at all times, no driving with boot on R foot | The reader must know what interim offloading and advice are in place before the appointment. |
| Plan: X-ray, MRI if X-ray normal, definitive immobilisation; ED if skin breaks or infection signs | Shows the expected work-up, and the patient's instruction on skin breakdown or infection, which the service should be aware of. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Wife's phone comments about him being stubborn and only caring about work | Third-party opinion about character, not clinical information, and not needed for triage. |
| GP 'brushed it off as a sprain'; very unhappy with practice | A complaint about another practice is not relevant to the referral purpose and could appear unprofessional. |
| Lives with wife and teenage children; enjoys fishing | Social detail that does not affect triage or the immediate management in this referral. |
| Appendicectomy 1995 | Unrelated past surgery with no bearing on the foot problem or the specialist assessment. |
| L hallux neuropathic ulcer 2022: healed; ex-smoker; alcohol 2–3 drinks/wk | Trap: looks like foot history but is resolved or minor here; compress or omit unless space allows after key items. |
| Phoned foot service; escalate via urgent pathway if no appointment by next working day | Internal follow-up arrangement for the referrer; the reader already knows about the call, so it need not be repeated. |
A paragraph plan for this case
Open with the purpose: urgent triage and specialist assessment of suspected acute Charcot neuroarthropathy. Then give the relevant background and today's history and findings. Finish with interim management and advice given, the planned investigations and immobilisation, and a brief close.
Where candidates slip on this task
- Do not write the twist as the cause of the swelling. Report only that he twisted the foot about three weeks ago and carried on working, leaving the reader to interpret it.
- Give the complete interim instructions: boot at all times, removal only for hygiene and skin checks without weight bearing on the right foot, daily checks of both feet, and no driving with the boot on the right foot.
- Keep the timeframe clear: seen today, referral sent today, triage requested within one working day, and swelling for two weeks. Do not blur these dates or durations.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Podiatry letter tasks
- Rheumatoid forefoot – continuity of care after relocation referral letter
- Falls-risk foot assessment – older woman update letter
- Aged care resident – suspected peripheral arterial disease update letter
Your profession's guide: OET Podiatry. Layout and structure: OET letter format.
Questions about this task
Should I mention the GP's earlier assessment?
Only if framed neutrally, and here it is better left out. The patient's unhappiness and the comment about the GP are not needed for triage. You may mention that the GP was informed by phone today, as this is relevant.
Do I include the driving advice?
Yes. He drives an automatic car, and he was advised not to drive while wearing the boot on his right foot. This is a practical safety point arising from the treatment, so a brief mention is appropriate.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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