SITUATION
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People with diabetes are at increased risk of foot problems. Regular foot examination and adequate pressure relief must be offered to hospital in-patients, particularly during illness, bedrest and during a peri operative period. Pressure sores at the heel and trauma to feet are important to prevent and can be difficult to treat.
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BACKGROUND
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Neuropathy, vascular disease and foot ulceration are complications of diabetes and amputation rates are higher in patients with diabetes. Diabetic foot ulceration is principally associated with peripheral vascular disease (PVD) and peripheral neuropathy, often in combination. Other factors that increase the risk include previous amputation, previous ulceration, the presence of callus, joint deformity and visual or mobility problems. See SIGN 116 for further details.
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ASSESSMENT
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- Examine feet daily, including the around the heels and between the toes
- Assess suitability of foot wear and check footwear for small objects or rough seams
- Establish current foot condition and facilitate medical review of active foot lesions
- If foot lesion is present identify a plan for on going treatment, review and redressing
- Determine presence of neuropathy
- Foot risk stratification guidelines are available in the Screening and Management of Foot Complications Section of the Tayside Diabete MCN Handbook.
- A web based foot screening competency tool is available in the Professional Education section of the MCN website or at www.diabetesframe.org
- Monitor blood glucose and refer to ward medical staff or Diabetes Team for advice if blood glucose control is problematic
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RECOMMENDATION
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- Facilitate and support self care of feet and conduct appropriate daily foot examination for people who unable to self care
- Examine feet daily, including the around the heels and between the toes
- Provide basic foot care education for each patient to reduce the chance of foot problems
- Prevent trauma to feet by ensuring that appropriate foot wear is available, patients should not walk with bare feet
- Ensure that foot dressings are changed appropriately: wound management guidelines are available http://www.nhstaysideadtc.scot.nhs.uk/TAPG%20html/MAIN/Front%20page.htm
- Agree treatment and document a management plan for patients with active foot problems
- Ensure adequate pressure relief for feet in patients with neuropathy
- Pressure relief devices (such as Podus boots) can be ordered via Orthotics Store using a ‘non stock purchase requisition’ form. It is advantageous to stock a small supply of Podus boots in the ward for early intervention
- These splints provide relief of heel pressure and are suitable for patients who are immobile or who require bed rest and they can be worn when patients are in bed or sitting
- Use pressure relief splints for patients with neuropathy and / or vascular problems
- Refer patients with foot problems appropriately to podiatry at hospital discharge
- Use podiatry referrals form to refer to Podiatry
- The Handbook section on Screening and Management of Foot Complications provides further information regarding foot care and treatment recommendations
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Tayside Specialist Foot service
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A Multidisciplinary Specialist Foot Clinic is held weekly in the Strathmore Diabetes Centre at Ninewells Hospital. Podiatrists with a special interest in diabetes are available in Perth Royal Infirmary, Arbroath Infirmary and Whitehills Community Care Centre in Forfar.
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Podiatry Contact Details
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Westgate HC Podiatry Department
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Tel: 01382 641154
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Strathmore Diabetes Clinic, Ninewells
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Tel: 01382 660111 ext 33509
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PerthRoyal Infirmary
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Tel: 01738 478390 / 473759 ext 13759
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Whitehills, Forfar
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Tel: 01307 475056
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Specialist Registrar for Diabetes
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Tel: 01382 660111 bleep 5416
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Orthotics Store T.O.R.T Centre, Ninewells
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Tel: ext. 36292
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PODIATRY REFERRAL FORM: IN-PATIENTS
Patient CHI Number
SURNAME …………………………………. ….. FORENAME ………………………………..
Patient’s GP ……………………………….. … GP Practice …………………………………
Hospital ……………………………………… … Ward ……………………………………….
Expected date discharge ……………………Could be escorted to clinical area: YES/NO
SITUATION
Reason for referral
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BACKGROUND
Medical history e.g. diabetes, rheumatoid disease, immuno-suppressed, dementia.
Details of steroid or other immuno-suppressive therapy; allergies.
Whether supervision/assistance will be required
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ASSESSMENT
Description of foot problem including:
Open wound
Presence of foot infection and outcome of swab
Treatment to date
Mobility issues
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RECOMMENDATION
Outline podiatry requirements
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DESIGNATION
SIGNATURE
DATE
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PLEASE RETURN COMPLETED FORM TO: PODIATRY DEPARTMENT, respective address.
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