Diabetic foot problems

This is a new guideline from NICE on assessing and managing people with diabetic foot problems.

Foot problems are very common in people with diabetes and come with huge morbidity. The following are some surprising statistics:

  • 10% of people with diabetes will get a foot ulcer at some point in their lives.
  • 1 in 3 people with diabetes  over the age of 50 have peripheral arterial disease.
  • 50% of those with an ulcer will die within 5 yrs
  • 70% will die within 5 yrs of an amputation.

Risk Assessment of patients

The following are risk factors for diabetic foot problems:

  • Neuropathy 
  • Limb ischaemia 
  • Ulceration.
  • Callus.
  • Infection and/or inflammation.
  • Deformity.
  • Gangrene.
  • Charcot arthropathy (beware redness, warmth, swelling or deformity - though deformity and pain may not be present)

Low Risk - no risk factors

Moderate Risk - one risk factor

High Risk - more than one risk factor OR

  • Previous ulceration
  • Previous amputation
  • On dialysis
  • Active foot disease (eg infection, critical ischaemia or gangrene)

Management

Admit - when you admit a patient because of a diabetic foot problem, advise the foot protection service too.

Foot Protection Service - see patients with diabetic foot problems and for avoidance of deterioration. If there are active foot problems, they should see patients within 48 hrs. If you suspect Charcot arthropathy, advise non-weight bearing).

Moderate or High Risk Patients - should be referred to the Foot Protection Service and should be seen regularly by them:

  • Moderate risk - 3 - 6 months
  • High risk - 1 - 2 months
  • High risk with immediate concern - 1 - 2 weeks

Low Risk patients - should be reviewed annually

Osteomyelits. This can occur with normal x-rays and normal inflammatory markers, so if you have a high index of suspicion, seek specialist advice.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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