Diabetes Footcare Guidelines

This guideline covers Podiatry Service referral for Diabetic Foot for the Northern locality. A diagram of the guideline is available here.

The aim is prevention of foot ulceration by ensuring that risk status is identified and patients are educated and appropriately referred.

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Primary care annual foot review

Foot examination with shoes and socks removed
Screening of diabetic foot
- Test sensation using 10g monofilament
Feel for foot pulses
Check for ulceration
Inspect for deformity
Classify foot risk & advise patient
Inspect for significant callus
Ask about previous ulceration
Check footwear
Ask about pain
Provide foot care education
Refer to Podiatry if any risk factors identified

Ulcerated/Infected Foot

Follow Acute Diabetes Foot pathway - Refer within 24 hours

Neuropathic foot ulcer
Neuroischaemic foot ulcer
Infection and or non-healing or non-improving skin break/ulcer more than 4 weeks duration.
Red swollen area on foot or early stages of foot ulceration
Foot problem needing vascular assessment but not urgent
Infection of a superficial ulcer
Antibiotic therapy should be initiated where there is superficial or localised evidence of infection. It is important to remember that a non-limb-threatening infection can become quickly limb threatening particularly in the neuroischaemic foot. Classification will also depend on the pathogenic mix and virulence factors and on the immune and general physiological status of the person (follow locally agreed Antibiotic guidelines).

Refer to multidisciplinary foot protection team (see referral information).

Suspected Acute Charcot Joint

Follow Acute Diabetes Foot Pathway

Hot swollen neuropathic foot. Pain/soreness.
+/- history of trauma
No signs of systemic infection

Emergency admission

Severe infection or sepsis – to Medical Assessment Unit (MAU)

Telephone: 01823 333444

Severe Infection

Features may include:

Cellulitis, discoloration, swelling, malodour or crepitus
Presence of soft tissue necrosis
Systemic symptoms of infection
Bone visible or wound probes to bone
Lack of response of infection to oral antibiotics

Critical ischaemia – refer direct to vascular on-call at Musgrove Park Hospital Taunton

Telephone: 01823 333444 to vascular surgery

Features may include:

Discoloration of toes (pale, dusky, black)
Signs of necrosis/ulceration
Pain at rest, often at night
Cold limb/foot
Diminished/absent pulses

Risk Stratification

Low:

Primary Care Annual Foot Assessment
Agree management plan with patient to include foot education and Primary Care annual review.

Increased Risk:

Neuropathy or vascular insufficiency plus other risk factors e.g. foot deformity, footwear, hard skin, social factors etc.

Refer to Community Podiatry – use standard Podiatry referral form (see referral section below).

High Risk

Neuropathy and Vascular insufficiency Plus increased risk factors e.g. foot deformity etc. and or previous history of ulceration/amputation.

Refer to Community Podiatry – use standard Podiatry referral form (see referral section below).

Referral Instructions

NDDH multidisciplinary foot protection team

Urgent review is needed for:

A diabetes foot problem presenting as a hot swollen foot; Evidence of Tissue Necrosis, Gangrene, Pus collection in the foot, Spreading Cellulitis, Patient feeling systemically unwell from sepsis, Rest pain. Please contact vascular consultant on-call at Musgrove Park Hospital Taunton Tel 01823 333444

If above not contactable patient should be admitted via A&E

Non urgent cases

Discuss with Podiatry team member - Telephone 01271 341507 during office hours 8:30 - 16:00, Monday - Friday.

Use Acute Diabetes referral form and email to ndht.podiatry@nhs.net