Lower limb injury
Foot injury after a motor accident
A foot injury may involve the calcaneus, talus, midfoot, metatarsals, toes, tendons or nerves. WPI depends on the permanent functional and anatomical residual, not on pain, footwear changes or the fact that surgery occurred.
Motor accident injury
How can this injury happen?
Car or passenger collision
Pedal or footwell intrusion can crush the heel, midfoot, metatarsals or toes.
Motorcycle accident
A motorcycle may land on the foot or force it into inversion, eversion or axial loading.
Pedestrian or cyclist impact
A vehicle wheel or bumper may crush the foot, followed by additional twisting in the fall.
Injuries that can occur
- calcaneus, talus, navicular, cuboid or metatarsal fracture
- Lisfranc or other midfoot ligament injury
- toe fracture, dislocation or amputation
- tendon rupture, plantar injury or nerve damage
- post-traumatic deformity, arthritis or stiffness
Symptoms and functional problems
- difficulty push-off, balance or uneven-ground walking
- restricted hindfoot or toe movement
- shoe intolerance, swelling or altered loading
- sensory loss, weakness or dysaesthetic pain
Seek urgent medical assessment
Crush injury, threatened skin, open fracture, absent pulse, compartment symptoms or rapidly progressing numbness requires emergency assessment.
Clinical evidence
What findings matter?
The assessor should identify the injured joint and distinguish hindfoot, midfoot and toe consequences. Weight-bearing alignment, cartilage interval, active movement, deformity and neurological findings may select different methods.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| Weight-bearing X-ray, CT or MRI | Shows fracture, alignment, Lisfranc injury, union, cartilage and tendon pathology. | A radiology label does not establish the functional residual. |
| Active hindfoot and toe ROM | Measures inversion/eversion and relevant toe movement. | Passive movement and pain do not set the rating. |
| Alignment, shoe and neurological examination | Records deformity, callosity, sensory loss, motor deficit and practical loading. | Shoe preference or altered gait is not a standalone percentage. |
Movement in daily life
How movement affects real activities
Hindfoot inversion and eversion adapt to uneven ground; toe movement and alignment support balance and push-off. A calcaneal or midfoot injury may impair loading even where ankle dorsiflexion remains relatively preserved.
Hindfoot inversion and eversion
Balance on slopes and uneven surfaces.
AMA4 Table 43 addresses active hindfoot movement.
Toe movement
Push-off, balance and fitting ordinary footwear.
Table 45 addresses active toe movement where applicable.
Foot and toe ankylosis/deformity
Foot placement, shoe tolerance and efficient walking.
Tables 44 and 60-61 may apply when exact criteria are met.
Threshold injury is a separate question: fracture or verified partial/complete ligament, tendon, cartilage or nerve injury may be non-threshold. Bruising or sprain without rupture may remain threshold.
Part 6 permanent impairment
How is CTP WPI assessed?
Potential methods include Tables 43 to 45 for movement/deformity, Tables 60 to 61 for foot/toe ankylosis, Table 62 for arthritis and Table 64 for diagnosis-based estimates. The most specific valid method is required.
Measurement rules that apply
- Clauses 6.69 and 6.70 require the method that most specifically addresses the lower-limb impairment. Gait should not replace a joint, nerve, fracture or replacement method that can be applied reliably.
- Clause 6.84 requires active range of motion, a goniometer where clinically indicated and consistent repetitions when reliability is uncertain. Passive movement may inform the examination but does not set the impairment value.
- Clause 6.85 says only the most severe deficit in one direction or axis from the same lower-limb ROM table is rated. Deficits from separate tables may be combined only as the Guidelines permit.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Movement or deformity | Clauses 6.84-6.85; AMA4 Tables 43-45 | Reliable permanent hindfoot/toe movement loss or verified deformity. | Do not duplicate the same consequence across tables. |
| Ankylosis | Clauses 6.86-6.87; Tables 60-61 and Guidelines Table 6.2 | A genuinely fixed foot or toe joint. | Stiffness is not automatically ankylosis. |
| Arthritis or diagnosis estimate | Clauses 6.88-6.100; Tables 62 and 64 | Proper radiographic cartilage loss or a listed fracture/diagnosis residual. | Exact row values and footnotes must be verified from readable AMA4. |
- Identify each affected joint and residual.
- Use weight-bearing radiology when alignment or cartilage is relied on.
- Convert lower-extremity impairment through Table 6.4.
What cannot be combined?
- arthritis with ROM, gait, atrophy or strength
- gait with another lower-limb evaluation
- movement and diagnosis methods for the same foot consequence
What does not establish WPI by itself?
- foot pain
- orthotics or special shoes alone
- fracture fixation
- non-weight-bearing imaging without clinical correlation
Motor accident examples
Calcaneus fracture with hindfoot stiffness
The assessor identifies whether the specific diagnosis, hindfoot movement, deformity or arthritis method best reflects the permanent residual.
Lisfranc fixation with ongoing pain
Fixation and pain do not set WPI; alignment, arthritis, movement and the verified diagnosis criteria matter.
Claim file preparation
Evidence checklist
Assessment source
Foot WPI assessment source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.68-6.75 and 6.84-6.110; AMA4 Tables 43-45, 60-64; Guidelines Tables 6.2, 6.4 and 6.5.
Threshold injury: Fracture or verified ligament/tendon/cartilage/nerve injury may be non-threshold; sprain or bruising may remain threshold.
What the assessor checks
- hindfoot/toe movement
- ankylosis
- arthritis radiology
- diagnosis-based method
What does not establish the result by itself
- pain
- orthotics
- fixation
- imaging alone
Official sources
Related NSW CTP guides
Free claim check
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Frequently asked questions
- Does a foot fracture have fixed WPI?
- No. The most specific valid method is applied to the permanent residual.
- Do orthotics prove impairment?
- No. They may support function but do not replace objective findings and a valid method.
- How is hindfoot movement assessed?
- Active inversion and eversion are addressed by Table 43.
- Can arthritis and movement be combined?
- No where arthritis is used, under clause 6.91.
- Is a Lisfranc injury non-threshold?
- A verified ligament rupture or fracture may be non-threshold, subject to causation and diagnosis.