Alarm Features starring the High Risk Diabetic Foot
Sue RobbPodiatrist
Foot Health Service West Hertfordshire Community Health Services
in 5
minutes!?
The Diabetic Foot – when to refer
• QOF screening – Who is high risk?
• Alert! ] refer to Foot Health Service
• Alarm ! ] urgent referral, & include Foot Health Service
Risk features of neuropathic foot• Warm foot, well-perfused,
bounding pulses, distended veins due to a-v shunting
• Sweating i skin dry/fissured
• Distal (below knee) symmetrical sensory loss
• Deformity, flexed toes, high arch, prominent met heads
• High pressure points a callus
QOF points
Neuropathic ulceration• Plantar metatarsal heads,
apecies of toes• High vertical pressures • Ulcer covered/surrounded by
callus, macerated by discharge
• Usually painless – pain first sign infected
• Good circulation – necrosis develops secondary to infection
Charcot arthropathy
Neuropathic osteoarthropathy - non infective destruction of bone
Affects patients with neuropathy
Acute phase mimics infection Casting stabilisation / non-
weight bearing essential Weight bearing e ‘bag of
bones’ appearance e ulcer from deformity
Neuroischaemic foot
• Atrophic thin frail shiny skin
• Diminished/absent foot pulses• Pallor on elevation• Rubor on dependency due to
capillary dilatation
• Intermittent claudication / rest pain, yet may be pain free
• Unforgiving foot
QOF points
Neuroischaemic ulceration• Ulcers on margins of feet
associated with trauma and fragile micro circulation
• Thin glassy callus or no callus
• First sign? - skin discolouration that blisters
• Pain may be due to infection or ischaemia
Identify high risk at screening
• High risk - presence of any risk factor for ulceration.
• Refer to FHS + continue screening
Risk factors for ulceration are 1. Previous ulceration /
amputation2. Neuropathy3. Absent/diminished pulses4. Deformity / LJM5. Callus6. Oedema7. Visual loss8. Self neglect / disability
No risk factors for ulceration = Low current risk Foot care education + annual screening. No FHS ref
Infection
<OsteomyelitisLook for signs of response to t/t in 3 days
callus
Sausage shaped toes“Beef chipolatas”Probe to bone
Pre ulcerative
Prevention of diabetic foot ulceration
• Good glycaemic control essential• Education – improve foot care knowledge
and behaviour• Daily foot check• Appropriate footwear• Timely vascular intervention• ‘High risk’ patients referred to Foot Health
Service
‘Team’ working prevents problems
• Early recognition and referral of the ‘at risk’ foot• Early detection and referral of ulceration,
Charcot, severe infection, acute/critical ischaemia• ‘Shared care’ programme – diabetes team, GP, nurse, podiatry and patient
Thank you for listening ……
Useful websites –www.diabeticfootjournal.co.uk
www.footindiabetes.orgwww.feetforlife.org