the diabetic foot - nhsggc.org.uk · active foot disease definition: presence of active ulceration,...
TRANSCRIPT
THE DIABETIC FOOT
Gillian Harkin
Podiatrist
Foot Problems In Diabetes
• Ischaemia
• Neuropathy
• Foot Deformity
• Combination
• Infection
Ischaemic Foot
• Absent Pulses
• Cold
• Cyanotic/pale
• Dry, shiny skin
• Lack of hair
• Atrophied nails
• Intermittent Claudication
• Rest pain
• Gangrene
Vascular Assessment
• Test
– Palpate Pulses
– Doppler
– Capillary Refill Time
• Observe
– Skin Quality Changes
– Temperature
Gradient
– Colour Changes
Neuropathy
SENSORY
10g monofilament
MOTOR
Visual
AUTONOMIC
Visual
Peripheral Neuropathy
Sensory Neuropathy
• Numb
• Tingling/shooting
pains/pins and
needles
• Charcot Foot
Motor Neuropathy
• Deformity
• High pressure areas
• High medial
longitudinal arch
• Claw toes
• Callus/ corns
Autonomic Neuropathy
• Warm
• Dry skin
• Fissures
• AV shunting
• Prominent veins
• Oedema
• Palpable, bounding
pulses
Neurological assessment
Test
• Vibration perception
• 10g monofilament
Observe
• Foot deformity
• Skin changes
Foot Deformity
• Hallux Valgus
• Pes Cavus
• Pes planus
• Hallux rigidus
• Lesser Toe
Deformities
• Osteoarthritis
• Charcot Foot
Charcot Foot
• Condition causing weakness
of the bones in the foot
• Can occur when there is
significant neuropathy
• Bones fragment, fracture,
dislocate followed by new
bone formation
• Symptoms may include:
• Warm to touch
• Redness in the area
• Swelling of the foot
• Pain
Additional Risk Factors
• History of ulcers
• History of amputation
• Callus
• Ill-fitting footwear
• Visual impairment
• Smoking/ alcohol intake/
obesity
• Poor glycaemic control
• Other medication e.g. Steroid
therapy
Diabetic Foot Screening Objectives
• To identify a patient with a foot problem
• To indicate those at risk of developing
problems
• To make a diagnosis based on the result
• To develop a treatment plan
• To refer to other disciplines if necessary
• To compare with previous examinations
Why Use SCI – Diabetes ?
• Quick, simple & easy to use
• Standardise screening
across NHS Scotland
• Takes into account all the
main risk factors
• Automatic risk stratification /
calculation
• Prevents duplication
• Secure, shared information
• Onward referral when
required
5%
5% Active ulcers or Infection.
Revascularisation or Amputation Multidisciplinary foot care team management15% High risk
Intensive ‘foot protection’’
20% Moderate risk
Regular ‘foot protection’
The Pyramid of Foot Care for a population of people with Diabetes
(Young 2006)
20%
15%
60% Low risk
Routine annual screening
60%
RISK TRIANGLE
‘TRAFFIC LIGHTS’
Low RiskDefinition: No risk factors
present e.g. no loss of
sensation, no signs of
peripheral vascular disease
and no other risk factors.
Action: Annual screening by a
suitably trained Health Care
Professional. Agreed self
management plan. Provides
written and verbal education with
emergency contact numbers.
Appropriate access to podiatrist
if/when required.
Moderate RiskDefinition: One risk factor present e.g.
Loss of sensation or signs of peripheral
vascular disease without callus or
deformity.
Action: Annual assessment by a
podiatrist. Agreed and tailored
management/treatment plan by
podiatrist according to patient
needs. Provide written and
verbal education with
emergency contact numbers.
High Risk
Definition: Previous ulceration or
amputation or more than one risk
factor present e.g. Loss of sensation
or signs of peripheral vascular
disease without callus or deformity
Action: Annual assessment by a
podiatrist. Agreed and tailored
management/treatment plan by
specialist podiatrist according to patient
needs. Provide written and verbal
education with emergency contact
numbers. Referral for specialists
intervention if/when required.
Active Foot Disease
Definition: Presence of active ulceration,
spreading infection, critical ischaemia,
gangrene or unexplained hot, red,
swollen foot with or without the presence
of pain.
Action: Rapid referral to and management
by a member of a Multidisciplinary Foot
Team. Agreed and tailored
management/treatment plan according to
patient needs. Provide written and verbal
education with emergency contact numbers.
Referral for specialist intervention when
required.
Diabetes Referral PathwayActive Foot Disease
Active Diabetic Foot
Disease Present
Refer to MDFC at
same site as diabetes
care provided
Does the patient
attend a secondary
care site for diabetes
management
Refer to local diabetes
foot clinic
Refer to Primary Care
Podiatry
No
Yes
No
Yes
Other Resources
• Leaflets, (in various languages)
– www.diabetesinscotland.org.uk
– www.mydiabetesmyway.scot.nhs.uk
• SCI-Diabetes DVD and Hand Book
– www.diabetesframe.org
• Local Specialist Diabetic Podiatrist
• Multi-disciplinary Diabetic Foot Clinic
– GG-UHB@[email protected]
– GG-UHB@[email protected]
Thank You