When you have your annual foot review, the examiner will assess your feet and determine your risk of developing serious foot problems. This will be classified as:
- low current risk (normal sensation, palpable pulses)
- increased risk (neuropathy or absent pulses or other risk factor)
- high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer)
- ulcerated foot or active foot disease.
At the end of your annual foot check you will be told what your risk is and it will be documented in your notes.
Low risk
If you are at low current risk of foot ulcers (normal sensation, palpable pulses)
This means that you are doing the right things and so the examiner will discuss and agree with you an ongoing management plan that includes foot care education.
Information and advice if you are found to be at low risk (PDF, 151KB).
Increased risk
If you are at increased risk of foot ulcers (neuropathy or absent pulses or other risk factor)
You should be referred to a member of the foot protection team.
The members of the team vary from area to area but whoever sees you will assess and deliver what treatment you need.
You will then be reviewed at three-to-six monthly intervals by someone from the foot protection team.
At each review your feet will be examined, the blood supply to your feet will be checked, and your footwear will be inspected.
You will be given the opportunity to discuss your day-to-day footcare.
Information and advice if you are found to be at moderate or increased risk (PDF, 126KB).
High risk
If you are at high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer)
You should be referred to a member of the foot protection team.
The members of the team vary from area to area but whoever sees you will assess and deliver what treatment you need.
You will then be reviewed at one-to-three monthly intervals by someone from the foot protection team.
At each review your feet will be examined and the blood supply to your feet will be checked.
If necessary and appropriate you will be given:
- intensified foot care education
- specialist footwear and insoles
- skin and nail care.
If you have any disabilities or immobility special arrangements for access to the foot protection team will be made for you.
Information and advice if you are at high risk (PDF, 128KB).
If you have a foot ulcer
If it is a new foot ulcer, you should be referred urgently (within 24 hours) to an appropriately trained health professional.
If you already have an ulcerated foot, ongoing care will be undertaken without delay by a multidisciplinary team. (1)
Information and advice if you have a foot ulcer (PDF, 154KB).
What are foot protection and multidisciplinary teams?
The Foot Protection Team (FPT)
This team is made up of healthcare professionals with specialist expertise in the assessment and management of disease of the foot in diabetes.
This may be a podiatrist, diabetes specialist nurse, diabetologist and/or vascular surgeon.
Members of the FPT will work closely with the Multidisciplinary Team (MDT) and may also be members of it. (2)
The Multidisciplinary Team (MDT)
This team should include
- a specialist podiatrist
- an orthotist
- a diabetologist with expertise in lower limb complications
- a surgeon with expertise in managing diabetic foot problems
- a diabetes nurse specialist
- a nurse with training in dressing of diabetic foot wounds
- a tissue viability nurse.
They should have unhindered access to services for managing major wounds, urgent inpatient facilities, antibiotic administration, community nursing, microbiology diagnostic and advisory services, orthopaedic/podiatric surgery, vascular surgery, radiology and orthotics. (2)
Reviewed: April 2013
Next review: November 2014
References
- NICE CG 10: www.nice.org.uk/CG10
- Putting feet first: national minimum skills framework, March 2011 (PDF, 330KB)
- SIGN 116 Management of diabetic foot disease, March 2010: www.sign.ac.uk/guidelines/fulltext/116/index/html