Foot Problems

Detection and surveillance

Detection and surveillance of foot problems are a routine part of Annual Review

Organize a recall system to ensure it occurs regularly for every individual

Examine yearly :

foot shape, deformity, joint rigidity, and shoes

foot skin condition ( fragility, cracking, oedema, callus, ulceration )

foot and ankle pulses

sensitivity to monofilament or vibration, and pin prick

Assess yearly :

history of foot problems since last review

visual and mobility problems preventing self-care of feet

self-care behaviours and knowledge of foot care ( including carer if appropriate )

Categorize as :

Foot ulcer :

active foot ulceration

High risk :

neuropathy or vascular disease or previous ulcer or Charcot foot

At risk :

deformity or self-care problem or simple skin problem

low current risk

Monitor related factors ( blood glucose control, claudication, drug therapy, smoking )

Foot management - preventative

High risk foot
	Involve a specialist in diabetes foot care
	Provide :
		regular foot assessment
		local preventative attention to callus
		relief of pressure using foam spacers, made-to-order shoes, customized insoles
		regular foot care education - the commandments of foot care
		vascular referral if symptoms or critical arterial supply
At risk foot
	Provide :
		routine foot care according to need
		advice on appropriate footwear
		foot care education at routine visits
		advice to careers

Foot management - advanced disease

Established foot ulceration / infection

Involve your local diabetes foot team without delay

Uselocal measures including:

	debndement and trimming of callus		foot casts to relieve pressure
	dressings to absorb exudate		surgical drainage

Use systemic and proximal measures including:

intravenous or oral antibiotic therapy - usually staphylococcal coverage, plus wider spectrum, anaerobes, or streptococcal as specifically indicated

vascular referral, investigation, and reconstruction / angioplasty if indicated

Reserve amputation for :

uncontrolled pain ( secondary to vascular disease )

debilitating, long-term, non-healing ulceration

a useless and disabling infected or Charcot foot

Foot ulceration is usually preventable Amputation, even if foot ulceration occurs, is nearly always preventable