Diabetic Foot Problems

 

The risk of foot problems in people with diabetes has increased, largely because of either diabetic neuropathy (nerve damage or degeneration) or peripheral arterial disease (poor blood supply due to diseased large- and medium-sized blood vessels in the legs), or both. Peripheral arterial disease affects 1 in 3 people with diabetes over the age of 50, and can also increase the risk of heart attack and stroke

Foot complications are common in people with diabetes. It is estimated that 10% of people with diabetes will have a diabetic foot ulcer at some point in their lives.  Diabetes is the most common cause of non-traumatic limb amputation, with diabetic foot ulcers preceding more than 80% of amputations in people with diabetes.  Mortality rates after diabetic foot ulceration and amputation are high, with up to 70% of people dying within 5 years of having an amputation and around 50% dying within 5 years of developing a diabetic foot ulcer

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Assessing the risk of developing a diabetic foot problem

NOTE The diabetic foot assessment pathway is no longer part of the KCHFT Podiatry Service.  Patients with diabetes, who do not have any foot pathology, will need to be seen by their GP for continuing foot checks and annual diabetic foot assessments (see below)

A referral to the Podiatry Service should only be made by a healthcare professional when a foot pathology, which requires management, is identified

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For adults with diabetes, assess their risk of developing a diabetic foot problem at the following times:

  • When diabetes is diagnosed, and at least annually thereafter
  • If any foot problems arise

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When examining the feet of a person with diabetes, examine both feet for evidence of the following risk factors:

  • Neuropathy (use a 10 g monofilament as part of a foot sensory examination)
  • Limb ischaemia
  • Ulceration
  • Callus
  • Infection and/or inflammation
  • Deformity
  • Gangrene
  • Charcot arthropathy

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Diabetic foot problems

If a person has a limb-threatening or life-threatening diabetic foot problem, refer them immediately to acute services and inform the multidisciplinary foot care service, so they can be assessed and an individualised treatment plan put in place. Examples of limb-threatening and life-threatening diabetic foot problems include the following:

  • Ulceration with fever or any signs of sepsis
  • Ulceration with limb ischaemia
  • Clinical concern that there is a deep-seated soft tissue or bone infection (with or without ulceration)
  • Gangrene (with or without ulceration)

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For all other active diabetic foot problems, refer the person within 1 working day to the multidisciplinary foot care service or foot protection service for triage within 1 further working day

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Diabetic foot infection

All hospital, primary care and community settings should have antibiotic guidelines covering the care pathway for managing diabetic foot infections that take into account local patterns of resistance

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Charcot arthropathy

Suspect acute Charcot arthropathy if there is redness, warmth, swelling or deformity (in particular, when the skin is intact), especially in the presence of peripheral neuropathy or renal failure. Think about acute Charcot arthropathy even when deformity is not present or pain is not reported

To confirm the diagnosis of acute Charcot arthropathy, refer the person within 1 working day to the multidisciplinary foot care service for triage within 1 further working day. Offer non-weight-bearing treatment until definitive treatment can be started by the multidisciplinary foot care service

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When examining the feet of a person with diabetes, examine both feet for evidence of the following risk factors:

  • Neuropathy (use a 10 g monofilament as part of a foot sensory examination)
  • Limb ischaemia
  • Ulceration
  • Callus
  • Infection and/or inflammation
  • Deformity
  • Gangrene
  • Charcot arthropathy

Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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