Transcript Alarm Features in the High Risk Diabetic Foot

Alarm Features
starring the High Risk Diabetic Foot
Sue Robb
Podiatrist
Foot Health Service West
Hertfordshire Community Health Services
The Diabetic Foot – when to refer
• QOF screening – Who is high risk?
• Alert!
] refer to Foot Health Service
• Alarm !
] urgent referral, & include
Foot Health Service
QOF points
Risk features of neuropathic foot
• Warm foot, well-perfused,
bounding pulses, distended
veins due to a-v shunting
• Sweating i skin dry/fissured
• Distal (below knee) symmetrical
sensory loss
• Deformity, flexed toes, high
arch, prominent met heads
• High pressure points a callus
Neuropathic ulceration
• Plantar metatarsal heads,
apecies of toes
• High vertical pressures
• Ulcer covered/surrounded by
callus, macerated by discharge
• Usually painless – pain first sign
infected
• Good circulation – necrosis
develops secondary to infection
Charcot arthropathy
 Neuropathic osteoarthropathy non infective destruction of
bone
 Affects patients with
neuropathy
 Acute phase mimics infection
 Casting stabilisation / nonweight bearing essential
 Weight bearing e ‘bag of
bones’ appearance e ulcer
from deformity
QOF points
Neuroischaemic foot
• Atrophic thin frail shiny skin
• Diminished/absent foot pulses
• Pallor on elevation
• Rubor on dependency due to
capillary dilatation
• Intermittent claudication / rest
pain, yet may be pain free
• Unforgiving foot
Neuroischaemic ulceration
• Ulcers on margins of feet
associated with trauma
and fragile micro
circulation
• Thin glassy callus or no
callus
• First sign? - skin
discolouration that
blisters
• Pain may be due to
infection or ischaemia
Identify high risk at screening
No risk factors for ulceration = Low current risk
Foot care education + annual screening. No FHS ref
• High risk presence of any
risk factor for
ulceration.
• Refer to FHS +
continue screening
Risk factors for ulceration are
1. Previous ulceration /
amputation
2. Neuropathy
3. Absent/diminished pulses
4. Deformity / LJM
5. Callus
6. Oedema
7. Visual loss
8. Self neglect / disability
Pre ulcerative callus
Sausage shaped toes
“Beef chipolatas”
Probe to bone
<Osteomyelitis
Look for signs of response to t/t in 3 days
Infection
Prevention of diabetic foot
ulceration
• Good glycaemic control essential
• Education – improve foot care knowledge
and behaviour
• Daily foot check
• Appropriate footwear
• Timely vascular intervention
• ‘High risk’ patients referred to Foot Health
Service
‘Team’ working prevents problems
• Early recognition and referral of the ‘at risk’ foot
• Early detection and referral of ulceration,
Charcot, severe infection, acute/critical ischaemia
• ‘Shared care’ programme –
diabetes team, GP, nurse, podiatry and patient
Thank you for listening ……
Useful websites –
www.diabeticfootjournal.co.uk
www.footindiabetes.org
www.feetforlife.org