1. MODERATE Risk
1 RISK FACTOR PRESENT Deformity OR Neuropathy OR Peripheral arterial disease No other risk factors
x6 more likely to ulcerate
Annual assessment by health care professional
Agree individual management/treatment plan
Written and Verbal Education with emergency contact details
Refer people who are at moderate or high risk of developing a diabetic foot problem to the foot protection service (community podiatry)

2. High Risk Previous ulceration/amputation/renal replacement therapy
or >1 risk factor
Loss of sensation Peripheral arterial disease
Deformity Significant callus
x83 more likely to ulcerate
Annual assessment by health care professional
Agree individual management/treatment plan
Written and Verbal Education with emergency contact details
Refer people who are at moderate or high risk of developing a diabetic foot problem to the foot protection service (community podiatry)

3. Foot Protection Service = Community Podiatry

4. Referrals accepted for Diabetes Patients with:
Moderate/High foot risk: Peripheral Neuropathy Peripheral Arterial Disease Renal Replacement Therapy History of Foot Ulceration
Low risk with:
Ingrowing Toenails
Symptomatic Nail Conditions
Corns
Callus
Foot Deformity
Heel Pain/Plantar Fasciitis
Timescales for Referral:
Moderate/High Risk with Urgent problem – Seen within 5 working days
Moderate/High Risk with Non-Urgent problem – Seen within 30 working days

5. Ingrowing Toenails Refer to Community Podiatry
Nail surgery: May be necessary, especially if recurrent/chronic
Carried out in local health centres by community podiatry
Patient may require: Improved glucose control advice
Antibiotics
Podiatrists will contact GP for support if these needed

6. What can podiatry do for the diabetic foot???
Prevention
Advice & Education
Treatment
Callus & Corn Reduction
Problematic Toenails
Nail Surgery
Functional Problems
Looking after Feet
Footwear
Risk Status
What can go wrong
Holiday Feet

7. How Do I Refer to Community Podiatry?

8. ‘Podiatry Service Referral Form’

9. Send to: Email: not-tr.PodiatrySPA@nhs.net (From NHS.net account)
Post to: Community Podiatry
Single Point of Access
Mansfield Community Hospital
Stockwell Gate
Mansfield
NG18 5QJ
For telephone queries please phone:
/ /

10. Ulcerated Foot (active foot disease)
Presence of active ulceration, spreading infection, critical ischaemia, gangrene, charcot, unexplained hot, red, swollen foot (with or without pain)
All Active Diabetic Foot Problems should be referred to Multi-Disciplinary Diabetes Foot Clinic
within 1 working day
NICE 2015
If a person has limb-threatening or life-threatening diabetic foot problem refer them IMMEDIATELY to acute service
IF FOOT GANGRENOUS OR CRITICAL LIMB ISCHAEMA SUSPECTED → STRAIGHT TO VASCULAR ONE-STOP
Now at: SURGICAL TRIAGE QMC Consultant/Registrar 24:7

11. Diabetic foot ulceration is defined as: “a wound penetrating through the dermis, below the ankle in a diabetic patient” International Working Group on the Diabetic Foot

12. How Do I Refer to Diabetes Foot Clinic?

13. Complete ‘Diabetes Foot Clinic’ Referral Form or Referral Letter
On Referral letter we need:
Medical history & Medication
What is the foot problem???
– duration, location, infection
Patient contact details
– telephone number please!
Communication Issues
Transport Issues

14. Please Note: Patient MUST have Diabetes
We do not accept referrals for painful neuropathy
We do not accept referrals for leg ulcers
Check:
Is the patient aware of referral?
Are they willing to attend?
Can they attend – do they need transport?
We cannot visit patients at home
We cannot accept patients in stretchers

15. Send to: Email: NUHNT.diabetesfootreferrals@nhs.net
(From NHS.net account)
Fax to: Diabetes Foot Clinic
Urgent Queries:
Phone Dundee House
or City Hospital ext 56622
And ask for Diabetes Foot Team
If Urgent Vascular:
Please contact Surgical Triage Unit at QMC

16. Who is the Diabetes Foot Clinic
Multi-Disciplinary Team of Medical and Health Professionals working together to treat
Active Diabetic Foot Problems

17. NUH – City Campus – Dundee House Multi-Disciplinary Team consists of:
Consultant Diabetologists Vascular Surgeons
Podiatrists Orthopaedic Surgeons
Orthotists Podiatric Surgeons
Plaster Room Microbiologists
Staff Nurses OPAT Team
Diabetes Specialist Nurses Radiographers
4 Days Consultant led MDT clinic
1 Day Pod/Plaster and MDT Ward Round
120+ Patients/Week
and rising

18. Soft tissue infection – IWGDF 2015 Recommends:
Do not offer antibiotics to prevent diabetic foot infections
Do not treat clinically uninfected wounds with antimicrobial therapy
Diabetic Foot Infection must be diagnosed clinically
All skin wounds harbour microorganisms, therefore their presence cannot be taken as evidence of infection
Clinical findings of infection and systemic inflammatory signs can be diminished by peripheral neuropathy and ischaemia
Start antibiotic treatment for suspected diabetic foot infection as soon as possible

19. Remember…
Keep an eye on those feet ! Thank You!

20. Further Information
NICE 2015 Diabetic Foot Problems: prevention and management,
NICE 2012 Lower limb peripheral arterial disease: diagnosis and management,
Scottish Intercollegiate Guidelines Network 116 Management of diabetes: A national clinical guideline
IWGDF 2015: Prevention and Management of Foot Problems in Diabetes Guidance Documents and Recommendations
Foot Risk Awareness and Management Education ww.diabetesframe.org
Charcot patient information