Transcript Diabetic Foot Screening

Every 30 seconds a lower
limb is lost somewhere in
the world as a consequence
of Diabetes.
The Lancet Volume 366
Issue 9498
Diabetic Foot Screening
Pathways, Posters and Leaflets
Produced by:
Foot and Lower Limb Working Group
Approved by:
East Lancashire Diabetes Network Clinical
Standards Group
Approved for use in:
Lancashire Care
East Lancashire Hospitals NHS Trust
ANNUAL SCREENING REVIEW
Symptoms
- Claudication
- Pain
- History of Ulcer
- Visual Impairment
- Mobility Problems
Inspection
- Callus
- Deformity
- Ulcer Present
Examination
- Skin Condition
- Pulses Present
- Sensitive to 10g
pressure (loss of 10g=
HIGH RISK)
CATEGORISE RISK
LOW RISK 0
MODERATE RISK 1
HIGH RISK 2
VERY HIGH RISK 3
Normal Flow
+/- Arterial Disease
+/- Arterial Disease
+/- Arterial Disease
- Protective Sensation
Intact (10g Pressure)
- Optimise Diabetes &
Blood Pressure Control
(<139/80)
- Foot Education
- Low Risk Advice Sheet
Podiatry Only For
Problems
- Loss of Protective
Sensation (10g Pressure)
- No Deformity
- No Callus
- No Previous Ulcer
- Loss of Protective
Sensation (10g Pressure)
- Deformity or Callus
Present
- No Previous Ulcer
- Loss of Protective
Sensation (10g Pressure)
- Ulcer Present or Previous
Ulcer
- Optimise Diabetes &
Blood Pressure Control
(<139/80)
- Foot Education
- Moderate Risk Advice
Sheet
- Consider Consultant
Opinion
- Footwear Assessment
(consider referral to
Regular Podiatry
Orthotist)
(12 Weekly)
- Optimise Diabetes &
Blood Pressure Control
(<139/80)
- Foot Education
- High Risk Advice Sheet
- Consultant Opinion
- Specialist Prescribed
Footwear or Shoe Review
- Optimise Diabetes &
Blood Pressure Control
(<139/80)
- Foot Education
- Very High Risk Advice
Sheet
- Consultant Opinion
- Specialist Prescribed
Footwear or Shoe Review
Regular Podiatry
(4-12 Weekly)
Regular Podiatry
(1-4 Weekly)
ARTERIAL DISEASE
+
- Abnormal flow
- +/- History of Claudication
If You Suspect Acute
Vascular Insufficiency
Ring: 01254 734 794
- Optimise Diabetes &
Blood Pressure Control
(<139/80)
- Prescribe Aspirin or Statin
- “Stop Smoking & Keep
Walking”
- Foot Education/ Arterial
Disease Advice Sheet
- Consider Consultant
Opinion
- Specialist Prescribed
Footwear or Shoe Review
ANNUAL REVIEW REGISTRATION
Advice & Urgent Assessments
Diabetes Footline Blackburn:
07866 684 362
(Diabetes Specialist Podiatrist or Nurse)
Podiatry Referrals
(Clinic or Domiciliary Visits)
Contact Local Health Centres
Footwear
Initial Supply- Consultant Referral
Repairs & Renewals
Blackburn: 01254 294 040 Burnley: 01282 804 602
Regular Podiatry
(1-4 Weekly)
LOW RISK
Protective sensation intact
(10g pressure)
Optimise diabetes and blood pressure control
(<139/80)
Foot education/Low risk leaflet
Podiatry only for problems
MODERATE RISK
•
Loss of protective sensation
•
No deformity
•
No callus
•
No previous ulcer
• Optimise diabetes and blood pressure control (<139/80)
• Foot education/Moderate risk leaflet
• Consider Consultant opinion
• Footwear advice and assessment
Regular Podiatry (12 weekly)
HIGH RISK
• Loss of protective sensation
• Deformity and/or callus present
• No previous ulcer
•
•
•
•
Optimise diabetes and blood pressure control (<139/80)
Foot education/High risk leaflet
Consultant opinion
Specialist prescribed Footwear/Shoe review
Regular Podiatry (4 – 12 weekly)
Very High Risk
• Loss of protective sensation (10 g pressure)
• Ulcer present or
• Previous ulcer
• Optimise diabetes & blood pressure control (<130/80)
• Foot education leaflets/ very high risk leaflet
• Consultant opinion
• Specialist prescribed footwear / shoe review
Regular podiatry and review
(1-4 weekly)
Arterial Disease
• Abnormal flow
• +/- History of claudication
• If you suspect acute vascular insufficiency
telephone: 07793 119344
• Optimise diabetes & blood pressure control (>139/80)
• Prescribe aspirin/statin
• ‘Stop smoking and keep walking’
• Foot education/leaflet
• Consider consultant opinion
• Specialist prescribed footwear /shoe review
Regular Podiatry especially nail care (1-12 weekly)
Annual Screening Review
Advice and Urgent Assessments:Screening referrals:- fax 617287
phone 282708
Podiatry Referrals: – Local Health Centres
Footwear: – Initial supply – Consultant referral
Repairs and renewals:
Blackburn – 01254 734040
Burnley -- 01282 804602
Hot Foot Line: – Blackburn 07866684362
Referral Pathways For The Diabetic Foot
Referral for Urgent
Problems
Referral for Non-urgent
Problems
Urgent Patient
Non Urgent Patient
Same Day Referral
Referral letter, or
fax (01254 736032)
Dr G.R. Jones,
Diabetes unit, RBH
Ring :Diabetes Hot Foot line
07866684362
Continue treatment
until Outpatient
Appointment
Condition becomes
urgent refer via RED
Lomax.G. McLaughlin.C. 2002
Pathway
Referral for Diabetic
Footwear
New
patient
Existing patient
Prescribed
footwear
Letter of
Referral to
Dr G.R. Jones,
Diabetes unit,
RBH
Orthotics
RBH Orthotics
RBH294040
01254 294040
01254
BGH 01282 804602
BGH
01282 804602
Ulceration/Hot Foot
REFER patients to a multidisciplinary foot care team within
24 hours if any of the following occur:
•
•
•
new ulceration (wound)
new swelling
new discolouration (redder, bluer, paler, blacker, over
part or all of foot).
(NICE Guideline – Type 2 diabetes: prevention and management of
foot problem)
REFER non-healing wounds from 0 – 4 weeks duration
The Diabetic Foot Clinics
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Since 1987 to heal foot ulceration
Multi-disciplinary team
Out Patients – Shorter or no admission
One stop clinic with holistic care
Management plan/ Shared care
Reduced no of amputations
Maintain patients independence
Easy accessibility
The Diabetic Foot Clinics
Pressure Relief
The Diabetic Foot Clinics
PRESCRIBED
INSOLES AND
FOOTWEAR
CAN PREVENT
FOOT
PATHOLOGY
The Diabetic Foot Clinics
 Ulcers are healed
 Shoes and insoles are fitted/Lifelong review
 Discharged back to you
 Refer back at any time