Alarm Features starring the High Risk Diabetic Foot

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Alarm Features starring the High Risk Diabetic
Foot
in 5 minutes!?

• Sue Robb
• Podiatrist
• Foot Health Service West
• Hertfordshire Community Health Services

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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

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Risk features of neuropathic foot
QOF points

• 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

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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

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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

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Neuroischaemic foot
QOF points

• 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

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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

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Identify high risk at screening
No risk factors for ulceration Low current
risk Foot care education annual screening. No
FHS ref

• Risk factors for ulceration are
• Previous ulceration / amputation
• Neuropathy
• Absent/diminished pulses
• Deformity / LJM
• Callus
• Oedema
• Visual loss
• Self neglect / disability

• High risk - presence of any risk factor
  for ulceration.
• Refer to FHS continue screening

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Infection
callus
Pre ulcerative
Sausage shaped toes Beef chipolatas Probe to
bone
ltOsteomyelitis
Look for signs of response to t/t in 3 days
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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

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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

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Thank you for listening Useful websites
www.diabeticfootjournal.co.ukwww.footindiabetes
.orgwww.feetforlife.org