THE ROLE OF THE PODIATRIST IN THE CARE OF THE DIABETIC FOOT

By Zoe Boulton

Contents

Assessment of the diabetic foot Features of ulcerations Debridement Dressings Biomechanics Offloading

General Role of the Podiatrist Identification of patients who are at risk

of developing foot problems Establish a risk score for patient as per

NICE guidelines (Low, Moderate, High) Providing appropriate treatment/

assessment Education to patients and other

professionals Work as part of larger multidisciplinary

team

Vascular assessment

Palpate pulses or use Doppler

Dorsalis Pedis Posterior Tibialis

ABPI

Can be useful in determining level of ischaemia

Carried out when ischaemia is suspected Values of: <0.8: the foot is at risk of

ulceration

<0.5: the foot is critically ischaemic

Caution: May give false readings in diabetic patients due to calcification of arteries consider pallor on elevation and dependant rubor also.

Neurological Assessment

Monofilament 8/10 or below neuropathy

Neurothesiometer

Above 25 volts indicates presence of peripheral

neuropathy

Typical features of Ulceration

Neuropathic Ischaemic

Pulses Bounding Diminished/absent

Pain None/minimal High degree of pain

Location of Ulceration

Pressure areas Borders of feet

Callus Often large amounts Minimal

Assessment of Diabetic Foot

Presence of Infection (bacteria and fungi) Ulceration/ foreign bodies Pre-ulcerative areas Deformity Oedema Skin quality Footwear

Debridement

Sharp debridement Allows true extent of ulcer to be revealed Allows healing with removal of slough

and dead tissue Maggots

Case Study

Patient presented after walking on a gripper rod.

This was also discovered …

Wound Bed

Granulating Sloughly

Dressings

Wound bed Consider patient Exudate management Moist healing environment Negative Pressure dressings Not the be all and end all !!

Biomechanics of foot

Altered foot function can be a cause of ulceration eg hallux limitus.

Forefoot equinus Glycosylation of tissues and amount of

deformity in foot can indicate severity of neuropathy

Offloading

Felt Bespoke insoles and footwear- rocker

soles PRAFO Aircast

Conclusion

Podiatrists work as part of a multidisciplinary team when managing the diabetic foot

The diabetic foot MUST be managed as part of a wide team involving a number of specialities.

We all aim to facilitate healing and ensure the best care for the patient

Thanks for listening