Boulton AJ, Armstrong DG, Albert SF, et al. Prediction of diabetic foot ulcer occurrence using commonly available clinical information: the Seattle Diabetic Foot Study. Diabetic foot problems: prevention and management. National Institute for Health and Care Excellence. Strong risk factors for diabetic foot complications include: sensory neuropathy, peripheral arterial disease, previous history of foot ulcer, previous history of major amputation, Charcot midfoot deformity, and end-stage renal disease. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Crawford F, Cezard G, Chappell FM, et al. These three factors can easily be screened without complex equipment. The key factors associated with occurrence or recurrence include the presence of sensory neuropathy (loss of protective sensation) the presence of vascular disease and/or a past history of an ulcer, Charcot neuroarthropathy, or amputation. Īn active ulcer immediately connotes a greater sense of urgency and should be classified according to the degree of tissue loss, the presence/degree of ischaemia, and the presence/degree of infection. Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Schaper NC, van Netten JJ, Apelqvist J, et al. The patient may have asymptomatic neuropathy, peripheral arterial disease, pre-ulcerative signs, or even an ulcer. ![]() This should be done even when there is no suspicion of diabetic foot complications.īear in mind that the absence of symptoms does not exclude foot disease. Identifying the presence of any foot ulcersĪssessing for any clinical symptoms or signs of infection, inflammation, or gangreneĪssessing for the presence of sensory neuropathy NICE recommends using a 10 g monofilament National Institute for Health and Care Excellence. The main goals of the initial evaluation include: Whenever a patient with diabetes presents with a foot problem of any kind. Whenever a patient with diabetes is admitted to hospital for any reason or if there is any change in their status during an admission When diabetes is diagnosed and at least annually thereafter in all patients with diabetes (more frequently for those assessed to be at moderate or high risk of foot complications) Ī structured assessment of the risk of foot problems must be done: National Institute for Health and Care Excellence. If the problem is limb-threatening or life-threatening, refer the patient immediately to acute services and follow your local protocol to inform the multidisciplinary foot care service. ![]() In the UK, the National Institute for Health and Care Excellence (NICE) recommends that any patient with an active diabetic foot problem should be seen by the multidisciplinary foot care team within 1 working day. As such, they have a key role in preventing and identifying active diabetic foot problems.ĭiabetologists, specialist podiatrists, and other medical specialists are key in the evaluation and management of these patients, both in multidisciplinary diabetic foot clinics and when patients with diabetes are admitted for other acute medical conditions. General practitioners and primary care nurses are generally on the front line of care for patients with diabetes.
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