Diabetes - Foot Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • The assessment and risk classification of the diabetic foot and the appropriate management and referral.
  • The guidance refers to adults age 18+ with diabetes

This guidance does not cover:

  • Children under the age of 18 years - Children 12 – 17 years are looked after by the diabetes specialist team.

Assessment

Diabetic Foot Assessment to include:

  • Testing of foot sensation using a 10g monofilament
  • Palpation of foot pulses
  • Check for ulceration
  • Inspect for deformity and callus
  • Inspection of foot wear
  • Ask about pain
  • Ask about previous ulceration
  • Classify foot risk and inform patient
  • Provide foot care education

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • Severe Sepsis
  • Critical Ischaemia

Management

Foot Attack - if evidence of:
  • Ulceration
  • Spreading infection
  • Critical ischaemia
  • Gangrene
  • Rest Pain (pain in the foot at rest or at night that prevents/wakens the patient up from sleep
  • Suspicion of Charcot arthropathy, or an unexplained hot, red, swollen foot with or without pain.
  • Refer promptly to the Multi-Disciplinary Specialist Foot Clinic / Diabetes Centre within 24 hours
    • Pinderfields – 01924 213516
    • Pontefract – 01977 747930
High Risk - if evidence of:
  • Previous ulceration
  • Previous amputation
  • On renal replacement therapy
  • Neuropathy and non-critical limb ischaemia
  • Neuropathy in combination with callus and/or deformity
  • Non-critical limb ischaemia in combination with callus and/or deformity

Management by the Community Podiatry Foot Protection Team (FPT) - 01924 541447/541448/541449

  • 1-3 monthly reviews
  • Enhanced foot care education
Increased Risk - if evidence of:
  • Deformity or
  • Neuropathy or
  • Absent Foot Pulses

Management by the Foot Protection Team - 01924 541447/541448/541449

  • 3-6 monthly reviews.
  • Enhanced foot care education
Low Risk - if evidence of:
  • Normal sensation
  • No sign of peripheral vascular disease
  • No other significant risk factors except callus alone

Management by the Primary Care Team

Referral

Referral Criteria

If Foot Attack (new foot disease or ulceration)
  • Manage infection by diabetes foot antibiotic guidelines
  • Refer promptly via the telephone to the Multi-Disciplinary Specialist Foot Clinic / Diabetes Centre within 24 hours:
    • Pinderfields – 01924 213516
    • Pontefract – 01977 747930
    • Dewsbury - 01924 816097
High Risk
Increased Risk
Low Risk
  • Continue Primary Care Annual Review to provide education about foot protection and diabetic foot attacks

Referral Instructions

  • e-Consultation is not currently available for podiatry
  • Referrals to the MYHT community podiatry - foot protection team (FPT) (Wakefield) should be made via a referral form
    • Please include the foot risk classification on the referral form
  • Referrals for General Podiatry via SPOC (Kirklees) - via SytmOne referral form or 0300 3045555
  • Referral to the MYHT Multi-Disciplinary Specialist Foot Clinic / Diabetes Centre should be made via telephone on
    • Pinderfields – 01924 213516
    • Pontefract – 01977 747930
    • Dewsbury - 01924 816097

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Evidence/Supporting Information

Assurance & Governance

  • This guidance was developed on: 02.2017
  • This guidance was ratified by:The OSCAR Assurance Group
  • Date ratified: 03.2017
  • Publication Date: 05.2017
  • Review Date: 02.2019
  • Ref No: END4 - 02.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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