Diabetic foot problems (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

 

Foot problem: Ulcer / Cellulitis / Necrosis / Tissue destruction / Malodour

Admit

Alternative diagnosis

Do not admit
  • Extensive cellulitis >2cm
  • Deep abscesses
  • Signs of systemic sepsis
  • Wet necrosis/significant tissue destruction

REFER TO SECONDARY CARE ACUTE ADMISSION UNIT
If admitted to peripheral hospital, arrange transfer to Raigmore Hospital.

 

Patient presents with:
Swollen, inflamed, hot, possibly painful foot without obvious ulcer or portal site for infection.

  • Initiate antibiotic therapy until diagnosis confirmed
  • X-ray to exclude fracture or foreign body.
  • Cellulitis <2 cm
  • No abscess
  • Patient systemically well
  • Dry necrosis/Limited tissue destruction

Refer to Diabetes Foot Clinic, see below

 

Consider Charcot Neuroarthropathy and follow management guideline

 

Referral to secondary care Acute Admission Unit

Must be classed urgent and by phonenot IUR/email

Spreading infection emergency admission to Medicine
01463 704000 and page 4000 (medical on call)
Or
Critical ischaemia contact on call Vascular Consultant 01463 704000

On Admission
Contact Diabetes team (ext 5322/5444)

Initial management plan in Acute Admission Unit

  • Aim for transfer to Ward 6C or 4B depending on nature of foot problem (Medical or Surgical)
  • Consider a variable rate intravenous insulin infusion if patient systemically unwell
  • Initial assessment should include removal of dressings, examination of feet to assess for indications of peripheral neuropathy (Touch-the-toes test recommended) AND
  • Palpation of dorsalis pedis and posterior tibial pulses in both feet
  • Refer to Highland Formulary Guidelines for inpatient Antibiotic Management
  • X-ray recommended
  • For appropriate wound dressings refer to NHSH Wound Management Guideline
  • Refer to podiatry Abban St 723250 to alert diabetes Specialist podiatrist for advice on wound management and local debridement (if appropriate)
  • Optimal foot protection – Check Protect Refer principles
  • Refer to orthotics for advice on pressure relief ext 4178
  • Consider referral to diabetes inpatient specialist nurse if appropriate ext 7934

Referral to Diabetes Foot Clinic

  1. Please Refer to Raigmore Hospital via SCI Gateway referral or letter. The patient can be expected to be seen in clinic soon.
  2. If there is any doubt concerning appropriate footwear or pressure refer to Orthotics Department, Raigmore Hospital (01463 704178).

This referral pathway will be different for patients in Argyll & Bute

Diabetic Foot Clinic appointments

SCI Gateway Referral to Abban Street Podiatry
Tel No 01463 723250
Any concerns about diabetes foot ulceration pre- or post -clinic day should be fielded through the Locality based Specialist Podiatrists.

Editorial Information

Last reviewed: 31/08/2020

Next review date: 31/08/2023

Author(s): Foot MDT.

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Consultant Physician.

Document Id: TAM152