Foot Care Workshop
First Hertfordshire Diabetes
Conference
23rd September 2014
Facilitators:Rebecca Gardner
Sandra Regan
Carolyn Wareham
Podiatry Diabetes Specialist Practitioners
Hertfordshire Community NHS Trust
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NICE Clinical Guidance 10
Type 2 diabetes Prevention and management of foot problems
On diagnosis of type 2 diabetes,
and at annual review thereafter
• examine patient's feet and lower
legs to detect risk factors –
include:
– testing of foot sensation using
10g monofilament or vibration
– palpation of foot pulses
– inspection for any foot deformity
– inspection of footwear
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NICE Clinical Guidance15
Type 1 diabetes: diagnosis and management of type 1 diabetes in
children, young people and adults
• Inspection and examination of
feet should include:
• Skin condition
• Shape and deformity
• Shoes
• Impaired sensory nerve
function
• Vascular supply ( including
peripheral pulses)
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Podiatry risk assessment
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Vascular assessment
Neurological Assessment
Deformity
Footwear
Foot health
Any other risk factor
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Risk classification
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At low current risk
At increased risk
At High Risk
Ulcerated foot / foot emergencies
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At low current risk
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Normal sensation
Palpable foot pulses
No callus or deformity
No previous ulceration
Footwear adequate
No referral to podiatry required
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Increased Risk
(Moderate Risk)
• Neuropathy
• Absent pulses
• Or other risk factor
Consider referral to podiatry
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At High risk
Neuropathy or absent
pulses plus deformity
or skin changes or
previous ulcer
Referral to podiatry
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Ulcerated foot
New ulceration, swelling, discolouration
Immediate referral to Podiatry
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Foot emergencies
New ulceration, swelling, discolouration
Admission and urgent referral to podiatry
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Case Study 1
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Case Study 2
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Case Study 3
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Hertfordshire Podiatry Service
Harpenden Memorial hospital
Carlton Road
Harpenden
AL5 4TA
Telephone 01582 711 544
Fax
01582 760 329
rebecca.gardner@hchs.nhs.uk
sandra.regan@hchs.nhs.uk
carolyn.wareham@hchs.nhs.uk
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