Remind your patients to go to their doctor straight away if they notice any of these during their foot check:
- An ulcer
- A scratch
- A cut
- A blister
- Feel pain
In case of a presence of a wound or a blister, cut or scratch it is key to react early and appropriately to avoid serious complications and potential amputation.
Remind your patients what to do if they notice a problem
If they notice something wrong, it is very important to:
- Take the weight off the foot
- Contact their GP or nurse as soon as possible
- Go to their nearest out-of-hours healthcare service if their GP or nurse are not available
It is extremely important to react early and appropriately before it gets any worse – no matter how small the wound. A serious foot problem for some patients could lead to amputation in a short period of time.
It is very important to remember to keep the weight off the foot.
A key success factor to close the wound and to avoid complications such as infection, and a potential amputation is to react early. It is very important that your patients and to react early to close the wound as soon as possible.
How to perform the appropriate referral
It is key to refer the diabetic patients with foot ulceration at the right time. Here are the international recommendations1 from DFOOT international to know when to refer your patients to specialized settings.
This is the recommended standard of care2 that will be put in place by the multidisciplinary team in a specialised setting.
Reduction of extrinsic and/or intrinsic biomechanical stress/plantar pressure is essential for ulcer protection and healing. The use of non-removable knee-high offloading devices, total contact casts (TCC), removable walkers or specific footwear should be used tailored to individual need and according to local available resources. Patients should be educated to minimise standing and walking. Regular follow-up should be undertaken to ensure clinical effectiveness and compliance.
treatment of infection:
When there are clinical signs of infection, empiric and broad-spectrum antibiotic therapy should be administrated after obtaining microbiological samples (ideally deep tissue), followed by adjustments according to clinical response and microbiological results. Removal of any necrotic or non-viable tissue following comprehensive assessment of infection severity is required.
metabolic control / holistic management:
Metabolic approach requires optimisation of glycaemic control (if necessary with insulin), the treatment of malnutrition and oedema if present. Optimal management of relevant co-morbidities is mandatory.
restoration of foot perfusion:
In patients with peripheral arterial disease (ankle pressure <50mm Hg, ABI <0.5, toe pressure <30mmHg or Tcp02 <25 mmHg), revascularisation should be considered. When an ulcer does not show signs of healing within 4 weeks, despite optimal management, further vascular assessment and revascularisation should be considered (even if the tests above fall within acceptable/normal ranges).
local wound care:
Frequent ulcer inspection/assessment, debridement and redressings should be undertaken. Dressing selection is based upon ulcer findings (characteristics of wound bed, exudation, size, depth, local pain). In case of neuro-ischemic ulcers, dressings with TLC-NOSF (Lipid-Colloid Technology with Nano-OligoSaccharide Factor) should be considered.
Make sure that your patient gets the appropriate level of care depending on its level of risk, even if there is no wound.
How to identify the Loss of Protective Sensation (LOPS)
Performing a sensory foot examination will help you identify the degree of Loss of Protective Sensation (LOPS).
Ideally use a 10g (5.07 SemmesWeinstein) monofilamentDownload tips & tricks
How to identify Peripheral Artery Disease (PAD)
There are two major foot pulses:
the anterior tibial artery on the dorsum of the foot, and the posterior tibial artery behind the medium maleolus. If you can not palpate one of the pulses this indicates that your patient probably has PAD.
In that case, you should plan a vascular assessment to confirm it.