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.

Assessment

Primary care annual foot review

  • Foot examination with shoes and socks removed
  • Screening of diabetic foot
  • 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

Red Flags

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)

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 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

Management

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

Referral Instructions

NDDH multidisciplinary foot protection team

For Urgent cases

If medically unwell refer patient to MAU at NDDH. Dr A Watt, Consultant Diabetologist, can be contacted for advice via NDDH switchboard 01271 322577 bleep 213.

Patients presenting with critical Ischaemia/requiring debridement refer to Mr David Williams Consultant Surgeon via vascular office 01271 322424, bleep 388 or on call surgical team via hospital switchboard 01271 322577.

After discussion with a team member use Acute Diabetes referral form and fax to:

Vascular office fax - 01271 335917

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

Non urgent cases

Discuss with Podiatry team member - Telephone 01271 341509

Use Acute Diabetes referral form and Fax to Podiatry 01271 321586 or email to ndht.podiatry@nhs.net

Referral Forms

Acute diabetes foot pathway referral form

Community Podiatry referral form

Supporting Information

Patient Information

Follow this link for a range of relevant patient information leaflets

Podiatry Services

Advice about your footwear

Diabetes Service

Looking after your diabetic foot ulcer

MyHealth patient information - Type 1 diabetes

MyHealth patient information - Type 2 diabetes

MyHealth patient information - Prediabetes

Evidence

Based on Diabetes UK/NICE "Putting Feet First", June 2012

Pathway Group

This guideline has been signed off on behalf of the Northern Locality of NEW Devon CCG.

Publication date: May 2015

 

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