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Prevention of active disease of the foot in those at increased risk

  • Referral of those at increased risk to the Foot Protection Team (FPT)* Foot risk status correlates closely with outcome. The need to document risk of each individual with diabetes was incorporated in QOF targets in April 2011. The 2011Diabetes in adults Quality Standard and the Diabetic Foot Risk Stratification and Triage (SIGN 116) also states that all people at increased risk will receive regular review by a member of a FPT. People with diabetes should be aware of their risk status and this entitlement. All people at increased risk should be referred promptly to a member of the FPT
  • Education of specialist staff and patients. It is necessary that those who examine the feet to determine risk status have the necessary training and competence. Training will be a role, which can be provided by the FPT. An essential part of the annual review of feet is patient education. The person with diabetes should be aware of the reason for the examination being undertaken, the results of the examination, the services to which they should have access if they require specific preventive measures and action to be taken if they develop a foot problem
  • A free online training programme is available at www.diabetesframe.org

Treatment of active disease of the foot

  • Active disease of the foot includes:
    • ulceration. All ulcers should be referred to the MDT within 24 hours
    • peripheral arterial disease without ulceration. People thought to have symptomatic peripheral arterial disease should be referred either to a vascular surgical unit for assessment, or to the MDT
    • acute Charcot foot. People with diabetes and neuropathy who develop unexplained inflammation of the foot should be assumed to have an acute Charcot foot and referred by phone for urgent assessment by the MDT. They should be told not to take weight on the foot until they have been seen
    • painful peripheral neuropathy. Guidelines for the management of painful neuropathy have been published (NICE CG96 'Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings' and SIGN 116 'Management of diabetes') and this can be supervised in general practice, provided that the GP is confident that the neuropathy is the cause of the pain. Referral to an MDT may be necessary for assessment
    • disease of the foot unrelated to diabetes. Symptoms or signs of other diseases should be managed appropriately

*Sometimes referred to as the Foot Care Team

A footcare pathway for people with diabetes

A footcare pathway for people with diabetes-compressed.jpg

Management of the person whose foot disease has been treated

  • Prevention of new foot disease. The person who has had an episode of foot disease has a 40 per cent risk of a second episode within 12 months. This group is at highest risk and they should:
    • remain under regular review by a member of the FPT or the MDT
    • understand the importance of prompt assessment by the MDT of any newly occurring problem
  • Reduction of cardiovascular risk. The average survival rate at five years is just 50 per cent for people who present with active disease of the foot. Average life expectancy is reduced by 14 years—even in those with predominantly neuropathic disease. As the main cause of increased mortality is cardiovascular, it is essential that all necessary steps are taken to reduce cardiovascular risk

Patient education

  • Advise the patient to:
    • check their feet every day
    • be aware of loss of sensation
    • look for changes in the shape of their foot
    • not use corn removing plasters or blades
    • know how to look after their toenails
    • wear shoes that fit properly
    • maintain good blood glucose control
    • attend their annual foot review

full guidelines available from…
Diabetes UK, 10 Parkway, London NW1 7AA (Tel – 020 7424 1000)

Diabetes UK. A footcare pathway for people with diabetes. 2012
First included: June 2012, updated July 2016.