Tayside Diabetes MCN Handbook
Pathway for Acute Diabetes Foot Disease

Defined as

  • Newly developed ulcer
  • Inflammation
  • Swelling
  • Infection
  • Acute pain in the absence of trauma


Criteria for Admission

  • Critical ischaemia/rest pain
  • Spreading cellulitis
  • Systemic infection from foot ulcer


A foot problem should be excluded in all patients with diabetes presenting with fever or unexplained ill health


Immediate Care: 0- 4 hours of Admission

  • Examine both feet – remove socks/bandages, check pulses, sensation and look for ulcers
  • Assess for infection. If present, give antibiotics promptly *
  • Unexplained swelling & inflammation of the foot?  Consider Acute Charcot Neuroarthropathy
  • Obtain input and advice from the Specialist Diabetes team as soon as possible
  • Review  glycaemic control and alter usual diabetes regimen if necessary
  • Request initial investigations


Second Phase Care: 4 - 24 hours of Admission

  • Review results of investigations and response to treatment
  • Consider the need for Vascular Surgery input
  • If the patient is fit for discharge and no Diabetes Team member is available (e.g. OOH/at the weekend), ensure that follow-up is arranged by emailing the patient’s Name, Address, CHI, Contact Number & Admission Details to: Tay-UHB.diabendoreferrals@nhs.net


Initial Investigations

  • Lab glucose
  • WCC
  • CRP
  • Consider blood cultures
  • Wound culture
  • Plain foot X-ray if osteomyelitis is suspected
  • Consider MRI


*Initial Antibiotic Choices


Cellulitis/ No Ulcer

As per Tayside Antibiotic Protocol

Ulcer – Antibiotic Naïve

Flucloxacillin 1g QDS

Ulcer – previous Antibiotic Therapy

See guidelines on reverse


Next Steps: If not improving

  • Correct antibiotic choice. Consider discussing with   Microbiology team
  • Consider Vascular Surgery input


Contact Vascular Surgery for:

  • Critical ischaemia/rest pain
  • Spreading cellulitis despite adequate antibiotic therapy
  • If debridement is required


Think Safety! Refer to the “Protecting Feet” SBAR Guidance

Remember to provide pressure relief using Podus Boots  

Refer to Diabetes Podiatry Team for ulcer care on discharge from hospital