Use the Torbay and Southern Devon NHS foundation Trust Diabetic Foot Referral Pathway Algorithm to classify the foot.

The foot should then be classified as being at low, moderate or high risk, the risk status documented and coded and the patient informed.

Other risk factors:

• An inability to self-care should be considered a risk factor. This could be due to e.g. a visual impairment or learning disability
• Patients on renal replacement therapy are at high risk of developing foot ulceration

• Spreading cellulitis
• Patient systemically unwell, (e.g. shivers, headache, unusually high sugars)
• Extensive ulceration and tissue necrosis
• Obvious abscess formation
• Mild to moderate infection
• Known PAD/neuropathy
• A hot, red, swollen foot or ankle where there is no known portal of entry for infection is highly indicative of Charcot arthropathy

Neuropathy

This is detected with a 10g monofilament. Test 3 sites on each foot. If the patient is unable to feel 1 out of 3 sites tested, this would indicate neuropathy.

Peripheral Arterial Disease (PAD)

Palpate the dorsalis pedis and posterior tibial arteries. If unable to palpate, this could indicate PAD. If Doppler ultrasound available, a monophasic signal would indicate PAD.

Callus and/or Deformity

Deformity and significant callus indicate high pressure areas under the foot which will be vulnerable to ulceration. When combined with neuropathy or PAD, this will put the foot at high risk of developing an ulcer.

Low risk:

• Issue Diabetic Foot Care – Low Risk leaflet and re-screen in 1 year
• Agree self-management plan

Moderate risk:

• Issue Diabetic Foot Care – Increased Risk leaflet and refer to podiatry for review as required and at least every 3 to 6 months
• Personalised treatment plan to include skin and nail care, review of footwear and need for insoles, targeted education

High risk:

• Issue Diabetic Foot Care – High Risk leaflet and refer to podiatry for review as required and at least every 1 to 2 months
• Personalised treatment plan to include skin and nail care, review of footwear and need for insoles, targeted education

Referral Instructions:

For urgent medical opinion:

• Refer to A&E or EAU immediately - phone MDT diabetes team 01803 655102

For Active ulcer, warning sign or suspected Charcot foot:

• Urgent referral to podiatry tel: 01803 217712 or e-mail: t-sd.podappts@nhs.net
• Telephone and email managed between 8:45am - 3:45pm

For new patients use the podiatry referral form

For presence of previous foot ulcer/amputation, undergoing renal replacement therapy, neuropathy, poor circulation, deformity/callus, inability to self-care send a non-urgent referral using the podiatry referral form to:

Podiatry Office
Castle Circus Health Centre
Abbey Road, Torquay TQ2 5YH

• Tel: 01803 217712
• Email: t-sd.podappts@nhs.net

Referral Form

Torbay and South Devon NHS Foundation Trust podiatry referral form

Patient Information:

• Diabetic Foot Care – Footwear Advice
• Diabetic Foot Care – High Risk
• Diabetic Foot Care – Increased Risk
• Diabetic Foot Care – Low Risk
• All Podiatry leaflets

MyHealth-Devon

• Type 1 Diabetes
• Type 2 Diabetes

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: September 2018