Every 30 seconds a lower limb is lost somewhere in

the world as a consequence of Diabetes.

The Lancet Volume 366

Issue 9498

Diabetic Foot ScreeningPathways, Posters and Leaflets

Produced by: Foot and Lower Limb Working Group

Approved by: East Lancashire Diabetes Network Clinical Standards Group

Approved for use in: Lancashire CareEast Lancashire Hospitals NHS Trust

ANNUAL SCREENING REVIEW

Symptoms - Claudication - Pain - History of Ulcer - Visual Impairment - Mobility Problems

Inspection - Callus - Deformity - Ulcer Present

Examination - Skin Condition - Pulses Present - Sensitive to 10g pressure (loss of 10g= HIGH RISK)

CATEGORISE RISK

LOW RISK 0 Normal Flow

MODERATE RISK 1 +/- Arterial Disease

HIGH RISK 2 +/- Arterial Disease

VERY HIGH RISK 3 +/- Arterial Disease

ARTERIAL DISEASE +

- Protective Sensation Intact (10g Pressure)

- Optimise Diabetes & Blood Pressure Control (<139/80) - Foot Education - Low Risk Advice Sheet

Podiatry Only For Problems

- Loss of Protective Sensation (10g Pressure) - No Deformity - No Callus - No Previous Ulcer

- Optimise Diabetes & Blood Pressure Control (<139/80) - Foot Education - Moderate Risk Advice Sheet - Consider Consultant Opinion - Footwear Assessment (consider referral to Orthotist) Regular Podiatry

(12 Weekly)

- Loss of Protective Sensation (10g Pressure) - Deformity or Callus Present - No Previous Ulcer

Regular Podiatry (4-12 Weekly)

- Loss of Protective Sensation (10g Pressure) - Ulcer Present or Previous Ulcer

- Optimise Diabetes & Blood Pressure Control (<139/80) - Foot Education - High Risk Advice Sheet - Consultant Opinion - Specialist Prescribed Footwear or Shoe Review

- Optimise Diabetes & Blood Pressure Control (<139/80) - Foot Education - Very High Risk Advice Sheet - Consultant Opinion - Specialist Prescribed Footwear or Shoe Review

- Abnormal flow - +/- History of Claudication

If You Suspect Acute Vascular Insufficiency Ring: 01254 734 794

- Optimise Diabetes & Blood Pressure Control (<139/80) - Prescribe Aspirin or Statin - “Stop Smoking & Keep Walking” - Foot Education/ Arterial Disease Advice Sheet - Consider Consultant Opinion - Specialist Prescribed Footwear or Shoe Review

Regular Podiatry (1-4 Weekly)

Regular Podiatry (1-4 Weekly)

ANNUAL REVIEW REGISTRATION

Advice & Urgent Assessments Diabetes Footline Blackburn:

07866 684 362 (Diabetes Specialist Podiatrist or Nurse)

Podiatry Referrals (Clinic or Domiciliary Visits)

Contact Local Health Centres

Footwear Initial Supply- Consultant Referral

Repairs & Renewals Blackburn: 01254 294 040 Burnley: 01282 804 602

LOW RISK Protective sensation intact

(10g pressure)

Optimise diabetes and blood pressure control (<139/80)

Foot education/Low risk leaflet

Podiatry only for problems

MODERATE RISK • Loss of protective sensation• No deformity• No callus• No previous ulcer

• Optimise diabetes and blood pressure control (<139/80)• Foot education/Moderate risk leaflet• Consider Consultant opinion• Footwear advice and assessment

Regular Podiatry (12 weekly)

HIGH RISK• Loss of protective sensation• Deformity and/or callus present• No previous ulcer

• Optimise diabetes and blood pressure control (<139/80)• Foot education/High risk leaflet• Consultant opinion• Specialist prescribed Footwear/Shoe review

Regular Podiatry (4 – 12 weekly)

Very High Risk• Loss of protective sensation (10 g pressure)• Ulcer present or• Previous ulcer

• Optimise diabetes & blood pressure control (<130/80)• Foot education leaflets/ very high risk leaflet• Consultant opinion• Specialist prescribed footwear / shoe review

Regular podiatry and review (1-4 weekly)

Arterial Disease• Abnormal flow• +/- History of claudication

• If you suspect acute vascular insufficiency telephone: 07793 119344

• Optimise diabetes & blood pressure control (>139/80)

• Prescribe aspirin/statin• ‘Stop smoking and keep walking’• Foot education/leaflet • Consider consultant opinion• Specialist prescribed footwear /shoe review

Regular Podiatry especially nail care (1-12 weekly)

Annual Screening Review

Advice and Urgent Assessments:-

Screening referrals:- fax 617287 phone 282708

Podiatry Referrals: – Local Health Centres

Footwear: – Initial supply – Consultant referral Repairs and renewals:

Blackburn – 01254 734040

Burnley -- 01282 804602

Hot Foot Line: – Blackburn 07866684362

Lomax.G. McLaughlin.C. 2002

Referral Pathways For The Diabetic Foot

Referral for Diabetic Footwear

Referral for Non-urgent Problems

Referral for Urgent Problems

Urgent Patient

Same Day Referral

Ring :-Diabetes Hot Foot line 07866684362 Condition becomes

urgent refer via RED Pathway

Continue treatment until Outpatient Appointment

Non Urgent Patient

Referral letter, or fax (01254 736032)Dr G.R. Jones, Diabetes unit, RBH

New patient

Existing patient

Letter of Referral to Dr G.R. Jones, Diabetes unit, RBH

Prescribed footwear

OrthoticsRBH01254 294040BGH01282 804602

OrthoticsRBH 01254 294040BGH 01282 804602

Ulceration/Hot FootREFER patients to a multidisciplinary foot care team within24 hours if any of the following occur:

• new ulceration (wound)• new swelling• new discolouration (redder, bluer, paler, blacker, over

part or all of foot). (NICE Guideline – Type 2 diabetes: prevention and management of

foot problem)

REFER non-healing wounds from 0 – 4 weeks duration

The Diabetic Foot Clinics

Since 1987 to heal foot ulceration Multi-disciplinary team Out Patients – Shorter or no admission One stop clinic with holistic care Management plan/ Shared care Reduced no of amputations Maintain patients independence Easy accessibility

The Diabetic Foot Clinics

Pressure Relief

The Diabetic Foot Clinics

PRESCRIBED INSOLES AND FOOTWEAR CAN PREVENT FOOT PATHOLOGY

The Diabetic Foot Clinics

Ulcers are healed

Shoes and insoles are fitted/Lifelong review

Discharged back to you

Refer back at any time