Diabetic Footcare

Primary care annual foot review

Foot examination with shoes and socks removed

• Test sensation using 10g monofilament
• Feel for foot pulses
• Check for ulceration
• Inspect for deformity
• Classify foot risk & advise patient
• Inspect for significant callus
• Ask about previous ulceration
• Check footwear
• Ask about pain
• Provide foot care education

• Ulceration
• Critical Ischaemia or gangrene
• Infection
• Unexplained red, hot, swollen foot
• Suspected Charcot

Emergency admission

• Severe infection/Sepsis - to Medical Assessment Unit (MAU) Tel: 01752 437777 Acute GP Service for admission via MAU
• Critical ischaemia - direct to vascular surgery via SAU, FAO duty consultant Vascular Surgeon Tel: 01752 245060

Cases not requiring emergency admission refer to UHPNT Multidisciplinary Foot Team rapidly: email plh-tr.MultiDisciplinaryPodiatry@nhs.net or tel: 01752 439802

Manage infection according to formulary guidelines.

Severe neuropathic pain without ulceration

• Follow joint formulary guidance on diabetic neuropathic pain management
• If unresponsive or opiates required refer to UHP Pain Management Clinic

Risk Stratification

Low:

No risk factors other than callus:

• Normal sensation
• No sign of peripheral vascular disease

Continue primary care annual review and provide education about foot protection and diabetic foot attacks

Moderate (Increased) Risk:

• One risk factor present e.g.
  • Loss of sensation
  • Signs of peripheral arterial disease
  • Callus or significant deformity
  • Refer to Community Podiatry: Email: PCHCIC.Plymouth-Podiatry@nhs.net; Tel: 01752 434855 / 434848; Post: Nuffield Clinic, Baring Street, Plymouth
    • Assessment 3 – 6 monthly or according to need
    • Enhanced foot care education
    • Will consider the need for onward referral for specialist footwear and orthotics

• Deformity requiring surgical solution
  • Follow Orthopaedic MSK Foot & Ankle pathway

High Risk

• Previous ulceration or amputation OR more than one risk factor e.g.
  • Loss of sensation
  • Signs of peripheral vascular disease
  • With callus or deformity
  • On renal replacement therapy
  • Refer to Community Podiatry:Email: PCHCIC.Plymouth-Podiatry@nhs.net; Tel: 01752 434855 / 434848; Post: Nuffield Clinic, Baring Street, Plymouth
    • Assessment 1–3 monthly or according to need
    • Enhanced foot care education
    • Will consider the need for onward referral for specialist footwear and orthotics

Referral Instructions

Urgent cases

• Medically unwell patients with sepsis / red, hot, swollen foot :
  • Emergency admission via Medical Assessment Unit, University Hospitals Plymouth NHS Trust
• Patients with active critical Ischaemia / gangrene:
  • Emergency admission via Surgical Assessment Unit University Hospitals Plymouth NHS Trust
• Active ulceration / infection with red, hot, swollen digits / suspected Charcot:
  • Commence antibiotics; refer to University Hospitals Plymouth NHS Trust Multidisciplinary Foot Team for urgent review within 24-48 hours.
  • Email: plh-tr.MultiDisciplinaryPodiatry@nhs.net.
  • Tel: (01752) 439802.
• Infection with erythema but no swelling:
  • Commence antibiotics; refer to University Hospitals Plymouth NHS Trust Multidisciplinary Foot Team for review within 24-48 hours.
  • Email: plh-tr.MultiDisciplinaryPodiatry@nhs.net.
  • Tel: (01752) 439802.
• Deformity requiring surgical solution:
  • Follow Orthopaedic MSK Foot & Ankle pathway

Non urgent cases

Discuss with Community Podiatry team member - Telephone 01752 434855 / 434848

Referral Forms

University Hospitals Plymouth NHS Trust Multidisciplinary Referral Form

Community Podiatry referral form

Patient Information

Diabetes UK foot screen leaflet – High Risk

Diabetes UK foot screen leaflet – Moderate Risk

Diabetes UK foot screen leaflet – Low Risk

Diabetes UK leaflet - Ten tips for Healthy Feet

Diabetes UK leaflet – Touch the Toes Test

MyHealth-Devon

• Type 1 Diabetes
• Type 2 Diabetes

Evidence

Based on Diabetes UK/NICE "Putting Feet First", June 2012, revised May 2019

Pathway Group

This guideline has been signed off by the Western Locality Diabetes Foot Group and Western Locality on behalf of NHS Devon

Publication date: September 2018

Updated: November 2022