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Visual summary

Diabetic foot Primary care assessment and monitoring

General Look for signs of sepsis Visibly unwell Drowsy Abnormal breathing Abnormal pulse Fever
assessment

Foot examination Check for active disease Ulceration Rest pain Gangrene Cellulitis

Check foot Cold, pale or dusky May indicate ischaemia ISC Acute limb or Urgent referral
temperature life threatening to diabetic foot
and colour problems
Warm, red or swollen May indicate acute Charcot foot CHA centre or general
surgery
Check for Deformed nails Callus Macerated web spaces Skin fissures Hallux valgus
DEF lesions and
deformities Claw toes Hammer toes Pes cavus Rocker bottom foot Fungal infection

Screen for Absent Posterior tibial artery History of Ankle brachial index
PAD peripheral foot pulses intermittent (ABI) less than 0.9
Dorsalis pedis artery claudication
arterial disease Measure if possible

Screen for loss Test sensation Biothesiometer


An inability to sense a 10 gram pressure is
LOPS of protective with a 10 g
the current consensus definition of LOPS
monofilament
sensation Graduated tuning fork

Risk assessment MEDIUM RISK HIGH RISK


Deformity, loss of protective Previous amputation Any two of: loss of
LOW RISK sensation, or peripheral arterial disease or ulceration LOPS protective sensation,

Callus + + peripheral arterial


disease, and lesions
CAL alone DEF LOPS PAD PRE
PAD + DEF or deformities

Manage PAD* Routine referral Urgent referral


Patient education Statins + 1
Glycaemic control antiplatelet DIABETIC FOOT CENTRE
Exercise to Foot protection services Surgical management
When to seek help
improve circulation
Modifiable Callus debridement Nail care Wound debridement Amputations
risk factors Consider referral for
further investigations
Foot care and revascularization Liaison or
Vascular intervention and orthoses services
referral

* Adapted from NICE


guidance on diabetic
foot and peripheral
arterial disease Primary care LOW RISK MEDIUM RISK HIGH RISK
follow-up Every year Every 3–6 months Every 1–2 months

© 2017 BMJ Publishing group Ltd.


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