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Diabetes Foot Care

Checked: 28-02-2023 by Vicky Ryan Next Review: 27-02-2025

Overview

This guidance refers to patients with diabetes who have active foot problems.

EVERY PATIENT WITH DIABETES AND A NEW ACTIVE FOOT PROBLEM NEEDS REFERRAL

Ulceration above the ankle in a patient with diabetes should be managed as per the leg ulcer guidance.

Patients with diabetes develop foot ulceration more commonly than other people due to a combination of factors (neuropathy, change in foot shape/mechanics and poor perfusion).

More than 5% of people with diabetes develop a foot ulcer in their lifetime, with around 2% of people experiencing an active ulcer at one moment in time. Foot ulceration is also associated with a two and a half fold increased risk of premature death – 5% of patients are dead with a year of developing an ulcer, and 40% within 5 years. This is mainly due to an excess in cardiovascular related mortality. In England 135 people with diabetes undergo a lower limb amputation every week – it is estimated that up to 80% may be preventable. Care related to foot care and amputations in patients with diabetes is estimated to cost £927million to £1.13 billion per annum (2014/5).

The National Diabetic Foot Audit (https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/national-diabetes-foot-care-audit) has identified that the time taken between the patient first presenting with a foot problem to getting an expert assessment is the most important factor in reducing time of healing of foot ulcers and reducing the risk of amputation. In BNSSG, 67% of patients wait longer than 2 weeks between first being seen in the practice and having a specialist assessment - this is now mainly due to delay in decision to refer. In the rest of England & Wales only 25% of patients wait this long.

Diabetic foot problems: prevention and management (NG19)

Please also see the systemwide diabetic foot infection guideline in the Formulary section of Remedy

New active foot problems in person with diabetes

Referral

Immediate Referral

As above, if a patient needs immediate referral please either:

Contact Vascular on call team at Southmead Hospital via NBT Switchboard (0117 9505050),or
Use referapatient.org . Log in not required. Choose Southmead Hospital. Vascular Surgeons. Complete the on line form which will be reviewed urgently by the on call team.

Urgent Referral

All other patients with diabetes who present with non-life or limb threatening active foot conditions (see flow chart above) should be referred within 1 working day to the Community Footcare Team. This includes suspected Charcot arthropathy.

Referrals will be triaged by community foot care team within 1 working day. Please make this referral to the community podiatry team as you normally would do (this is normally via managed referral).

ANY healthcare professional can refer a patient.

The community team will review the referral and escalate for review in the secondary care diabetic foot service (7952085 Diabetic Foot Service RAS – Southmead Hospital) as required based on red flags in the referral or limited community capacity.

Expediting an Existing Referral

If a patient is seen in the practice with a deteriorating foot problem and is already known to the secondary care service (but does not have an immediately life or limb threatening problem) they should be re-escalated using referapatient®. Any healthcare team member can escalate using this service.

Sirona Community Podiatry Service

Please see the Community Podiatry Services page

Resources

Sirona’s Feet and Diabetes resources

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.