Referral

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Diabetic Footcare

Scope

Diabetic Footcare Pathway for the Western locality. A diagram of the guideline is available here.

The aim is prevention of foot ulceration by ensuring that risk status is identified and patients are educated and appropriately referred.

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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

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:
  • 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

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