Assessment and Management of Wounds In Diabetes. Maria Mousley Northamptonshire NHS Foundation Trust

Size: px
Start display at page:

Download "Assessment and Management of Wounds In Diabetes. Maria Mousley Northamptonshire NHS Foundation Trust"

Transcription

1 Assessment and Management of Wounds In Diabetes Maria Mousley Northamptonshire NHS Foundation Trust

2 Background At least people with diabetes in England have a foot ulcer at any given time There are around 6000 lower extremity amputations a year in people with diabetes Diabetic foot ulcers are the most common cause of non-traumatic limb amputation The risk of a lower extremity amputation in a person with diabetes is 23 x that of a person without diabetes

3 Background Diabetes is one of the biggest health challenges facing the UK today Diabetic foot problems have a significant financial impact on the NHS and a significant impact on patients quality of life.

4 Costs Average annual cost of one foot ulcer treatment? 3,600 (York Health Economics Consortium, The diabetic Foot. Vol 1; No 3, , 1998) Average cost of one lower limb amputation? 16,300-32,600 (IDF, 2005) Estimated Health Care budget in the UK Up to 502m per year (DoH 2002)

5 The Indirect Costs Pain Pain Restricted mobility Embarrassment Human Costs Costs Loss Loss of of earnings Social Social isolation Depression

6 Amputation Prevention Team (aka Diabetic Foot Team) Ward/OPD Referral Podiatry facilitator Primary Care / Community Referral Radiology Consultant Interventional Radiologist X-ray MRI Consultants Diabetologist Vascular Surgeon Orthopaedic Surgeon Microbiologist Extended Team Ward / Nursing Staff AHPs Supporting Team Vascular Laboratory Plaster Room Pathology Laboratory Adapted from RGF 1994 Diabetic Foot Team Services Ward Rounds OPD (complex clinic) Podiatry (ftwr, Wound Management)

7 Diabetic Foot Screening Diabetic Foot Protection Programmes Ward/OPD Referral Podiatry facilitator Primary Care / Community Referral MDfT Services Ward Rounds OPD (complex clinic) Specialist Podiatry (footwear, Wound Management) Amputation Prevention Team (aka Diabetic Foot Team)

8 Refer?...as?

9 Stage 1 - hard skin builds up (fire)

10 This may not be painful! (undetected) Pressure may not be noticeable at first

11 Stage 2 - Tissue damage begins beneath the surface (starts to spread)

12 Stage 3 - Skin breaks open and an ulcer is revealed. This is prone to infection. (spot the signs)

13 Prevention of Foot Attack Extravasation a precursor of ulceration

14 The faster you act the more of a foot you save

15

16 Escalating needs; deteriorating condition

17 Deterioration Wound getting worse Increase in size Increase in depth Development of complications

18 NEUROPATHIC VS ISCHAEMIC ULCERS Symptoms Circulation Site Presence of callus Signs of infection

19 Neuropathy Nerve damage in diabetes leads to altered pain sensation Tip of toes Big toe Ball of foot Heel area

20

21

22 Neuropathic Ulcer Granulation Deep Other structures exposed Callus Site: Weight bearing areas.

23 Clinical Examination Insensate foot: repeated minor trauma causes ulceration

24 The importance of neuropathy Ulcers will not heal unless offloaded Ulceration leads to infection, often exacerbated by poor diabetes control Untreated or inadequately treated infection leads to osteomyelitis Neuropathic ulcers may be small and apparently insignificant ALWAYS look under the dressing NB infection? cause

25 Pressure offloading Total contact casting is the gold standard AND REST!!!!!!!!

26 Peripheral Arterial Disease Palpate foot pulses:- Dorsalis Pedis Posterior Tibial Doppler sounds Monophasic? Ankle-Brachial Index (ABPI) <0.8

27 Ischaemic Ulcer Painful Cool Foot Pulseless Site: borders of the feet. Surrounding Erythema Necrotic centre

28 Neuroischaemic ulcers -Refer

29 Refer

30 Refer

31 Summary of Neuropathic foot ulcers NICE Clinical Guideline CG10 Type 2 Diabetes - Foot care 2004 CREST guidelines Neuropathic foot Warm Numb Dry Usually painless Palpable pulses Neuropathic foot ulcers Commonly resulting from callus On weight-bearing areas Punched out appearance

32 Summary of Neuroischaemic foot ulcers NICE Clinical Guideline CG10 Type 2 Diabetes - Foot care 2004 CREST guidelines Neuro-ischaemic foot Cool/cold to touch Absent/diminished pulses Pain at rest Neuro-ischaemic foot ulcers Commonly result from tight shoe On non-weight-bearing areas of foot, toe tips & beneath toenails

33 Tissue Necrosis Neuropathy Infection Ischaemia The Deadly Triad (Edmonds 1984))

34 Line of least resistance

35 Spreading infection

36 Mr G W 52 years April 10 picked hard skin off foot at base of R hallux Not diabetic but family history of diabetes in two relatives one an amputee Foot became infected generally unwell Saw private podiatrist and advised to go to GP Prescribed flucloxacillin over the phone

37 2 days later reviewed by podiatrist not happy and referred to A&E seen by orthopaedic SHO and advised to continue antibiotics and return in 2 days 2 days later (1 week after first became unwell) saw GP blood glucose 16.8 pyrexial cellulitis Admitted under orthopaedic surgeons for iv antibiotics

38 IV flucloxacillin and benzylpenicillin (hospital guidelines advise co-amoxiclav for diabetic foot infections) cultures subsequently grew haemolytic strep, staph aureus and anaerobes 2 days after admission, debrided by orthopaedic surgeon Further debridement 1 week later Referred to vascular surgeon and podiatrist

39

40

41 Aug 2010 completely healed and patient ambulant in therapeutic footwear

42 Missed Opportunities Primary care Lack of specialist knowledge and referral routes failure to assess patient delayed diagnosis of diabetes Secondary care failure to recognise need for intravenous antibiotics when seen in A&E inadequate antibiotic cover inadequate debridement failure to involve the specialist diabetic foot team

43 Neuropathic ulcer presentation with cellulitis and

44 Neuropathic ulcer - tracking

45

46 Initial examination and assessment If the following are present, obtain urgent advice from an appropriate specialist: redness or warmth are present systemic sepsis deep seated infection limb ischaemia

47 Kissing Ulcers Kissing Ulcers (Ref. Jeffcoate & Macfarlane 1995)

48

49 Tip, Top Toe! Increased presure (Ref. Irion 2002)

50 Avoidable pressure ulcers are a key indicator of the quality of care. Preventing them will improve all care for at risk patients (harm free care)

51

52 Debridement

53

54

55 Neuropathic Ulcer No pain Warm Foot Pulses present Profuse slough Conversion to Infection

56 Management

57 Managing infection in the diabetic foot Clinical Knowledge Summaries Type 2 Diabetes 2008 Infection presents a threat to (life and) limb and should be treated promptly and aggressively Foot care infections in patients with diabetes are classified as non-limb threatening (urgent referral to a multidisciplinary diabetes foot care team within 24 hours) or limb-threatening (usually require hospital admission) Infected diabetic feet should only be treated by clinicians who have sufficient experience and facilities available A non-limb threatening infection can quickly become limb threatening

58 Managing infection in the diabetic foot Clinical Knowledge Summaries Type 2 Diabetes 2008 Non - limb threatening Infection - refer within 24 hours Includes those with infection of a superficial ulcer, no bone or joint involvement, no signs or symptoms of systemic toxicity, no significant ischaemia If referral within 24 hours is not possible, start empiric antibiotic treatment in interim. If deeper infection, seek urgent advice Review after 7 days Swabs should be taken before starting antibiotics

59 Managing infection in the diabetic foot Clinical Knowledge Summaries Type 2 Diabetes 2008 Limb threatening infection - consider hospital admission Includes those with spreading cellulitis, systemic signs of infection, lack of response to oral antibiotics, malodorous wounds, soft tissue necrosis or suspected bone involvement

60 Continuum of microbial load Increasing bioburden %20Assessment-Pocket%20Guide.pdf

61 Conversion to Infection and necrosis

62 Why high risk wounds? Vascular disease Nerve damage Hyperglycaemia Underlying susceptibility to infection

63 Classic Signs of Infection Rubor et tumor cum calore et dolore redness pain swelling heat (Celsus c. 3-64AD)

64 Diagnose Infection Based on any 2 features (Berendt & Lipsky 2003) Feature Temperature Colour Swelling Pain Exudate levels Neuropathic Comparative increase Erythematous eg.pillar box red Localised generalised Little or none Increased, +/- viscosity Ischaemic Little change - cooler Little change - dusky red Little change Increased pain Minor increase in volume

65 Infectious Diseases Society of America Classification System (Lavery et al 2007) Mild <2cm cellulitis / erythema Superficial ulcer >2 Signs of inflammation No systemic illness Moderate No systemic illness As in mild infection and in addition > 1 of the following: >2cm cellulitis Lymphangitis Involvement of Tendon Joint Bone Severe Infection in a patient with systemic toxicity or metabolic Instability

66 REMEMBER. Risk of treating infection too late, with it s associated morbidity & mortality, while giving antibiotics freely carries a risk of inducing antibiotic resistance.use of clinical skills & judgement is vital!

67 What antibiotic do I use? Broad Spectrum Eg. Co-amoxiclav Culture and sensitivity Culture directed narrower spectrum

68 Antibiotics in Diabetic foot Disease IDSA Scottish Diabetes Group Consensus (Leese et al The Diabetic Foot Journal vol ) Clinical Knowledge Summaries (CKS) s

69 Treatment of infection Osteomyelitis

70 Management of diabetic foot ulcers When choosing wound dressings take into account: clinical assessment of the wound patient preference clinical circumstances eg granulating, sloughy, necrotic which wound dressing has the lowest acquisition cost.

71 Guidelines on wound and wound-bed management (2011) IWGDF Game et al 2012 Diab Metab Res Rev;28: In the absence of strong clinical or cost effective evidence, health care professionals should use wound dressings that best match clinical experience, patient preference, the site of the wound and the cost of the dressings. Wounds should be closely monitored and dressings changed regularly. (NICE, 2004 )

72 Health Technology Assessment

73 WHAT MAKES AN IDEAL DRESSING for High Risk Wounds.? Designed to minimise cross-contamination Maintains a moist environment for optimal wound healing (Sibbald et al, 2004) Absorption and retention at varying exudate levels (Chen et al, 2003) Minimises risk of damage to peri-wound skin (Jones et al, 2004) Conformable to the wound (Armstrong S.H. 2004) Versatile, for use on a wide range of wounds Comfortable for patient (Mortimer D) Control odour Easy to use Cost-effective

74 Wound bed colour... Black (necrotic) Yellow / grey (sloughy) Red (granulating) Pink (epithelising)

75 Think. Consideration should be given to the fact that these properties may be altered when dressing the feet (Morgan D, Formulary of Wpund Management Products, 7 th Ed: 26, 29-30, 1997) as dressings are not designed to take the high & repetitive forces exerted on the sole of the foot! (Baker N, Journal of Wound Care 6 (1): 1997) Friction Body weight pressure Movement High & repetitive forces Footwear accommodation INFECTION MASKED!

76 Vascular control.

77 Mechanical control. Rest Avoidance of pressure

78 Glycaemic control. Consider any systemic, metabolic or nutritional disturbances that may impair the response to infection and retard healing of wounds.

79 Educational control. Patient education / empowerment is critical if successful management is to be achieved. (Day J, Diabetes Metab Res Rev; 16 (Suppl 1): S70-74, 2000)

80 Key points for education (NICE 2004) Self-care and self-monitoring Knowledge of when & where to seek advice Awareness of possible consequences of neglecting the feet Management of symptoms (pain, odour)

81 Summary 1. Vascular disease 2. Nerve damage 3. Hyperglycaemia (infection) 4. Pt education

82 Questions?

83 Find out more Visit

84 References Banga JD. (1994), Lower extremity arterial disease in diabetes mellitus Diabetes Reviews International 3;4:6-11 Dejgaard A. (1998), Pathophysiology and treatment of diabetic neuropathy Diabetic Medicine 15: Edmonds ME. (1984), The Diabetic Foot Practical Diabetes 1;1:36 Young MJ et al. (1993), A Multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population Diabetologia 36:

The Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care

The Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care The Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care Anita Murray - Senior Podiatrist Diabetes, SCH Learning Outcomes Knowledge of the Model of Care For The Diabetic Foot

More information

Service Development Tool for the Assessment of Provision of Services for Patients with Diabetes Related Foot Problems

Service Development Tool for the Assessment of Provision of Services for Patients with Diabetes Related Foot Problems Division of Medicine & Community Services Service Development Tool for the Assessment of Provision of Services for Patients with Diabetes Related Foot Problems Graham Holt Advanced Practitioner / Podiatrist

More information

Management Of The Diabetic foot

Management Of The Diabetic foot Management Of The Diabetic foot Aims, Pathways, Treatments Nikki Coates 12/1/18 Diabetic foot pathology Neuropathy Foot deformity Vascular disease Sensory neuropathy Limited Joint Mobility Smoking Autonomic

More information

Diabetic Foot Ulcers. Care for Patients in All Settings

Diabetic Foot Ulcers. Care for Patients in All Settings Diabetic Foot Ulcers Care for Patients in All Settings Summary This quality standard focuses on care for people who have developed or are at risk of developing a diabetic foot ulcer. The scope of the standard

More information

Antimicrobial Guidelines for the Empirical Management of Diabetic Foot Infections

Antimicrobial Guidelines for the Empirical Management of Diabetic Foot Infections Antimicrobial Guidelines for the Empirical Management of Diabetic Foot Infections Version 7.2 PAGL Inclusion Approved at January 2017 PGC APPROVED BY: TRUST REFERENCE: B3/2017 AWP REF: UHL Policies and

More information

Model of Care for the Diabetic Foot

Model of Care for the Diabetic Foot Model of Care for the Diabetic Foot National Clinical Programme for Diabetes Clinical Strategy and Programme Division 2018 Revision number Document drafted by National Clinical Programme for Diabetes Working

More information

Clinical Guideline for: Diagnosis and Management of Charcot Foot

Clinical Guideline for: Diagnosis and Management of Charcot Foot Clinical Guideline for: Diagnosis and Management of Charcot Foot SUMMARY This guideline outlines the clinical features of Charcot foot (Charcot Neuroarthropathy). It also explains the process of diagnosis

More information

Foot Ulcer Workshop: Prevention and Management of Diabetic Foot Ulcers. Aparna Pal, Consultant Endocrinologist, RBH Keith Hilston, Podiatrist, BHFT

Foot Ulcer Workshop: Prevention and Management of Diabetic Foot Ulcers. Aparna Pal, Consultant Endocrinologist, RBH Keith Hilston, Podiatrist, BHFT Foot Ulcer Workshop: Prevention and Management of Diabetic Foot Ulcers Aparna Pal, Consultant Endocrinologist, RBH Keith Hilston, Podiatrist, BHFT High mortality and morbidity Complex condition, longterm

More information

Diabetes Foot Screening and Risk Stratification Tool

Diabetes Foot Screening and Risk Stratification Tool Diabetes Foot Screening and Risk Stratification Tool Welcome to the Diabetes Foot Screening and Risk Stratification Tool This tool is based on the work of the Scottish Foot Action Group (SFAG). It has

More information

Wound Assessment Report

Wound Assessment Report Wound Assessment Report Single Assessment, Single Wound Mary Taylor Assessment Patient ID MT4367147 Date of Birth 1939-4-18 Left Foot, Sole: Wound A Image taken 16-45-43 Area 1.7cm2 Perimeter 48mm Maximum

More information

Diabetes follow-up: What are the PHO Performance Programme goals and how are they best achieved? Supporting the PHO Performance Programme

Diabetes follow-up: What are the PHO Performance Programme goals and how are they best achieved? Supporting the PHO Performance Programme Diabetes follow-up: What are the PHO Performance Programme goals and how are they best achieved? Supporting the PHO Performance Programme 48 BPJ Issue 39 What are the goals? The PHO Performance Programme

More information

Implementing the updated NICE Guidance on the Diabetic Foot

Implementing the updated NICE Guidance on the Diabetic Foot Implementing the updated NICE Guidance on the Diabetic Foot Rachel Berrington Senior Diabetes Specialist Nurse Foot Lead University Hospitals of Leicester NHS Trust Key Priorities for Implementation NG19

More information

Putting feet first: national minimum skills framework

Putting feet first: national minimum skills framework In partnership with Putting feet first: national minimum skills framework The national minimum skills framework for commissioning of footcare services for people with diabetes Revised March 2011 This report

More information

Leg ulcer assessment and management

Leg ulcer assessment and management Leg ulceration The views expressed in this presentation are solely those of the presenter and do not necessarily represent the views of Smith & Nephew. Smith & Nephew does not guarantee the accuracy or

More information

ASSESSING THE VASCULAR STATUS OF THE FEET FOR PATIENTS WITH DIABETES

ASSESSING THE VASCULAR STATUS OF THE FEET FOR PATIENTS WITH DIABETES ASSESSING THE VASCULAR STATUS OF THE FEET FOR PATIENTS WITH DIABETES Caroline McIntosh is Senior Lecturer in Podiatry, University of Huddersfield, Yorkshire A reduced blood supply to the lower limb, due

More information

Looking after your diabetic foot ulcer

Looking after your diabetic foot ulcer Looking after your diabetic foot ulcer diabetes information and advice leaflet Emergency Action Plan FOOT ATTACK? If your foot is red, swollen or if you have breaks in the skin PHONE 07786250788 IMMEDIATELY.

More information

A new classification of the diabetic ischaemic foot promotes a modern approach to treatment. Michael Edmonds King s College Hospital London

A new classification of the diabetic ischaemic foot promotes a modern approach to treatment. Michael Edmonds King s College Hospital London A new classification of the diabetic ischaemic foot promotes a modern approach to treatment Michael Edmonds King s College Hospital London Disclosure Speaker name: Michael Edmonds... I have the following

More information

Bone and Joint Infections in Diabetics: Diagnosis and Management of Diabetic Foot and Other Common Lower Extremity Infections

Bone and Joint Infections in Diabetics: Diagnosis and Management of Diabetic Foot and Other Common Lower Extremity Infections Bone and Joint Infections in Diabetics: Diagnosis and Management of Diabetic Foot and Other Common Lower Extremity Infections Objectives How do you to diagnose, classify and manage DFI? How do you diagnose

More information

Venous Leg Ulcers. Care for Patients in All Settings

Venous Leg Ulcers. Care for Patients in All Settings Venous Leg Ulcers Care for Patients in All Settings Summary This quality standard focuses on care for people who have developed or are at risk of developing a venous leg ulcer. The scope of the standard

More information

Practical guidelines on the management and prevention of the diabetic foot 2011

Practical guidelines on the management and prevention of the diabetic foot 2011 DIABETES/METABOLISM RESEARCH AND REVIEWS Diabetes Metab Res Rev 2012; 28(Suppl 1): 225 231. Published online in Wiley Online Library (wileyonlinelibrary.com).2253 IWGDF GUIDELINES Practical guidelines

More information

How can DIABETES affect my FEET? Emma Howard Specialist Podiatrist and Team Leader, Oxford Health NHS Foundation Trust

How can DIABETES affect my FEET? Emma Howard Specialist Podiatrist and Team Leader, Oxford Health NHS Foundation Trust How can DIABETES affect my FEET? By: Emma Howard Specialist Podiatrist and Team Leader, Oxford Health NHS Foundation Trust HOW CAN DIABETES AFFECT MY FEET? What is neuropathy? This leaflet explains how

More information

Sores That Will Not Heal

Sores That Will Not Heal Sores That Will Not Heal Introduction Some sores have trouble healing on their own. Sores that will not heal are a common problem. Open sores that will not heal are also known as wounds or skin ulcers.

More information

VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT

VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT Lucy Stopher, A/CNS Vascular Surgery ...it is best to think of a wound not as a disease, but rather as a manifestation of disease. Joe McCulloch In order

More information

Looking after your diabetic foot ulcer

Looking after your diabetic foot ulcer Looking after your diabetic foot ulcer diabetes information and advice leaflet Emergency Action Plan FOOT ATTACK? If your foot is red, swollen or if you have skin breakdown RING 07786250788 IMMEDIATELY.

More information

Rapid Recovery Hyperbarics 9439 Archibald Ave. Suite 104 Rancho Cucamonga CA,

Rapid Recovery Hyperbarics 9439 Archibald Ave. Suite 104 Rancho Cucamonga CA, Foot at risk Age Well By Dr LIEW NGOH CHIN Are limb amputations due to diabetes preventable? DIABETES mellitus is a major global health problem and has reached epidemic proportions in many developed and

More information

The Diabetic foot. diabetic. foot. the

The Diabetic foot. diabetic. foot. the The Diabetic Some basic facts. Diabetes is on increase. Foot ulcers occur in 12% to 25% of people with diabetes. Diabetics who have had a ulcer are more likely to have a re occurrence. Diabetes is biggest

More information

HOW TO SPOT A FOOT ATTACK PREVENTING SERIOUS FOOT PROBLEMS

HOW TO SPOT A FOOT ATTACK PREVENTING SERIOUS FOOT PROBLEMS HOW TO SPOT A FOOT ATTACK PREVENTING SERIOUS FOOT PROBLEMS Your foot check has shown that there is a high risk that you could develop serious foot problems 2 YOUR FEET MATTER If you ve been given this

More information

Multidisciplinary diabetic foot project - Samoa

Multidisciplinary diabetic foot project - Samoa Multidisciplinary diabetic foot project - Samoa The World Health Organization and the International Diabetes Federation have stated that up to 85 percent of diabetic lower extremity amputations are preventable

More information

AIM OF MASTERCLASS. Overview of the diabetic foot disease. Modern approach to management

AIM OF MASTERCLASS. Overview of the diabetic foot disease. Modern approach to management AIM OF MASTERCLASS Overview of the diabetic foot disease Modern approach to management DIABETIC FOOT DISEASE THROUGHOUT THE WORLD, THERE IS AN AMPUTATION EVERY 20 SECONDS MOST OF THESE AMPUTATIONS ARE

More information

Foot protection for people with diabetes a focus on prevention

Foot protection for people with diabetes a focus on prevention Foot protection for people with diabetes a focus on prevention Presentation by Mike Townson Independent Podiatry Consultant. Facilitated by Angela Farrell Neubourg Pharma UK Ltd. Foot Assessment training

More information

Diabetes (DIA) Measures Document

Diabetes (DIA) Measures Document Diabetes (DIA) Measures Document DIA Version: 2.1 - covering patients discharged between 01/07/2016 and present. Programme Lead: Liz Kanwar Clinical Lead: Dr Aftab Ahmad Number of Measures In Clinical

More information

Resources to Guide the Management of Suspected Infection in Chronic Wounds

Resources to Guide the Management of Suspected Infection in Chronic Wounds Resources to Guide the Management of Suspected Infection in Chronic Wounds Health Improvement Scotland published their 13th Health Technology Assessment (HTA 13) in December 2015 entitled, Antimicrobial

More information

DRESSING SELECTION SIMPLIFIED

DRESSING SELECTION SIMPLIFIED 10 DRESSING SELECTION SIMPLIFIED It must be recognised that no one dressing provides the optimum environment for the healing of all wounds (Mahoney, 2015) DRESSING SELECTION SIMPLIFIED Selecting the correct

More information

Diabetic Foot Ulcers. Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C. Advanced Practice Nurse / Adult Clinical Nurse Specialist

Diabetic Foot Ulcers. Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C. Advanced Practice Nurse / Adult Clinical Nurse Specialist Diabetic Foot Ulcers Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist Organization of Wound Care Nurses www.woundcarenurses.org Objectives Identify Diabetic/Neuropathic

More information

Root Cause Analysis The Tools. Angie Abbott Head of Podiatry and Orthotics Torbay and Southern Devon

Root Cause Analysis The Tools. Angie Abbott Head of Podiatry and Orthotics Torbay and Southern Devon Root Cause Analysis The Tools Angie Abbott Head of Podiatry and Orthotics Torbay and Southern Devon Why do RCA s? To understand if the amputation was avoidable or unavoidable Learn and improve Identify

More information

Northumbria Healthcare NHS Foundation Trust. Preparing For Foot and Ankle Surgery. Issued by the Orthopaedic Department

Northumbria Healthcare NHS Foundation Trust. Preparing For Foot and Ankle Surgery. Issued by the Orthopaedic Department Northumbria Healthcare NHS Foundation Trust Preparing For Foot and Ankle Surgery Issued by the Orthopaedic Department This leaflet gives you information about what is involved in foot and ankle surgery.

More information

DIABETES AND FOOTCARE

DIABETES AND FOOTCARE DIABETES AND FOOTCARE Self-Care and Treatment for Healthy Feet Don t Take Your Feet for Granted Every day, you depend on your feet to keep you moving. But when you have diabetes, your feet need special

More information

Foot Care. Taking steps towards good FOR AT-RISK FEET. HIGH RISK of developing serious. Person with Diabetes

Foot Care. Taking steps towards good FOR AT-RISK FEET. HIGH RISK of developing serious. Person with Diabetes Taking steps towards good Person with Diabetes Foot Care FOR AT-RISK FEET Your healthcare professional has found that as a person with Diabetes your feet have a HIGH RISK of developing serious problems

More information

Diabetes - Foot Care

Diabetes - Foot Care Diabetes - Foot Care Introduction People with diabetes are more likely than others to have problems with their feet. These problems can lead to dangerous infections of the foot. Recognizing and treating

More information

A Patient s Guide to Inter Digital Neuralgia (Morton s Neuroma)

A Patient s Guide to Inter Digital Neuralgia (Morton s Neuroma) A Patient s Guide to Inter Digital Neuralgia (Morton s Neuroma) The foot and ankle unit at the Royal National Orthopaedic Hospital (RNOH) is a multi-disciplinary team. The team consists of two specialist

More information

Aetiology Macroangiopathy occurs mainly distally ie Popliteal artery There is arterial wall calcification Microangiopathy is less common

Aetiology Macroangiopathy occurs mainly distally ie Popliteal artery There is arterial wall calcification Microangiopathy is less common DIABETIC FOOT Facts 5% of the population is diabetic 12% of diabetic admissions are with foot problems 1/3rd of diabetic foot ulcerations are neuropathic, 1/3rd are ischaemic and 1/3 are of a mixed in

More information

Case Study 2 - Mr J. Medical history

Case Study 2 - Mr J. Medical history Case Study 2 - Mr J A 54 year-old male was referred to the podiatrist at Coast Provincial General Hospital Diabetic Clinic, for management of active foot disease. The patient s presenting complaint was

More information

Model of care for the diabetic foot

Model of care for the diabetic foot Model of care for the diabetic foot Item type Authors Citation Publisher Report National Diabetes Programme Working Group National Diabetes Programme Working Group. Model of care for the diabetic foot.

More information

Renal Foot Care. Christian Pankhurst

Renal Foot Care. Christian Pankhurst Renal Foot Care Christian Pankhurst The consequences of poor management of the renal foot are considerable: prolonged ulceration and ill health, gangrene and amputation, depression and death. The health

More information

Foot Care. Taking steps towards good FOR AT-RISK FEET. HIGH RISK of developing serious. Person with Diabetes

Foot Care. Taking steps towards good FOR AT-RISK FEET. HIGH RISK of developing serious. Person with Diabetes Taking steps towards good Person with Diabetes Foot Care FOR AT-RISK FEET Your healthcare professional has found that as a person with Diabetes your feet have a HIGH RISK of developing serious problems

More information

Diabetic foot problems

Diabetic foot problems Internal Clinical Guidelines team Draft for consultation Diabetic foot problems Prevention and management of foot problems in people with diabetes Clinical Guideline XXX Methods, evidence and

More information

Fixing footcare in Sheffield: Improving the pathway

Fixing footcare in Sheffield: Improving the pathway FOOTCARE CASE STUDY 1: FEBRUARY 2015 Fixing footcare in Sheffield: Improving the pathway SUMMARY The Sheffield Teaching Hospitals NHS Foundation Trust diabetes team transformed local footcare services

More information

AWMA MODULE ACCREDITATION. Module Five: The High Risk Foot (Including the Diabetic Foot)

AWMA MODULE ACCREDITATION. Module Five: The High Risk Foot (Including the Diabetic Foot) AWMA MODULE ACCREDITATION Module Five: The High Risk Foot (Including the Diabetic Foot) Introduction - The Australian Wound Management Association Education & Professional Development Sub Committee-(AWMA

More information

Insights on Diabetic Foot Management in UK

Insights on Diabetic Foot Management in UK Insights on Diabetic Foot Management in UK Presented by Helen CHU KEC POD I / TKOH POD i/c 2015/16 Overseas Corporate Scholarship Program for podiatrists in Diabetic Foot Management London / Leicester,

More information

Diabetes Mellitus and the Associated Complications

Diabetes Mellitus and the Associated Complications Understanding and the complications relating to the disease can assist the fitter to better serve patients. and the Associated Complications Released January, 2011 Total: 25.8 million people, or 8.3% of

More information

Diabetic foot Ulcer Dressings Guidance and Referral Advice

Diabetic foot Ulcer Dressings Guidance and Referral Advice Diabetic foot Ulcer Dressings Guidance and Referral Advice Approved By: Professional Advisory Forum Date: October 2002 Review Date: October 2003 Originator: Diabetic Foot Ulcer Working Group Diabetic foot

More information

Wound Care Evaluation by Kris Dalseg MS PT CWS CLT

Wound Care Evaluation by Kris Dalseg MS PT CWS CLT Wound Care Evaluation by Kris Dalseg MS PT CWS CLT This document is intended to describe a standard wound care evaluation for healthcare practitioners. In healthcare, all aspects of our treatment have

More information

Definitions and criteria

Definitions and criteria Several disciplines are involved in the management of diabetic foot disease and having a common vocabulary is essential for clear communication. Thus, based on a review of the literature, the IWGDF has

More information

Lesser toe deformities

Lesser toe deformities PATIENT INFORMATION Lesser toe deformities What are lesser toe deformities? Lesser toe deformities are caused by changes in normal anatomy that create an imbalance between the foot s muscle groups (intrinsic

More information

Diagnosing wound infection - a clinical challenge

Diagnosing wound infection - a clinical challenge Diagnosing wound infection - a clinical challenge Keith F Cutting Merimbula, 5 th November 2010 Wound infection microbial load immune system microbial load + + + immune system infection host response Diagnosing

More information

The Diabetic Foot Latest Statistics

The Diabetic Foot Latest Statistics The Diabetic Foot Latest Statistics There are 2.6 million people with diagnosed diabetes in the UK. There are predicted to be 500,000 who have the condition but are unaware of it. There are 11,859 in TH

More information

Effective Diagnosis of Local Wound Bed Infection. Julie Hewish Senior Tissue Viability Nurse Oxford Health NHS Foundation Trust

Effective Diagnosis of Local Wound Bed Infection. Julie Hewish Senior Tissue Viability Nurse Oxford Health NHS Foundation Trust Effective Diagnosis of Local Wound Bed Infection Julie Hewish Senior Tissue Viability Nurse Oxford Health NHS Foundation Trust Localised Wound Bed Infection is the Result of imbalance between patient s

More information

Advice for rheumatoid patients at risk of developing foot related problems

Advice for rheumatoid patients at risk of developing foot related problems Advice for rheumatoid patients at risk of developing foot related problems Other formats If you need this information in another format such as audio tape or computer disk, Braille, large print, high contrast,

More information

Leg Ulcer Case Study

Leg Ulcer Case Study Leg Ulcer Case Study Wound Healing Community Outreach Service Mrs Ivy Hurtzalot, a 71-year-old lady, presents to her general practitioner with an ulcer on her right medial malleolus. Ivy reveals that the

More information

Practical advice when treating feet

Practical advice when treating feet Practical advice when treating feet Helen Mandic Clinical Lead Podiatrist in Health Promotion and Student Mentor Department of Podiatry and Foot Health Dawlish Hospital Falls Prevention The Role of the

More information

Lead Diabetes Podiatrist Consultant in Acute Medicine and Diabetes Diabetic Foot Lead Consultant

Lead Diabetes Podiatrist Consultant in Acute Medicine and Diabetes Diabetic Foot Lead Consultant Title: DIABETIC FOOT INFECTION Ref No: 1461 Version 3 Classification: Guideline Directorate: Organisation Wide Due for Review: 05-05-2020 Responsible for review: Lead Diabetes Podiatrist Consultant in

More information

Foot and Ankle Surgery

Foot and Ankle Surgery Information about Foot and Ankle Surgery Statement of Use The information in this leaflet is intended solely for the person to whom it was given by the health care team and is provided as a general information

More information

Rapid Foot Screening

Rapid Foot Screening GP Symposium 2015 Workshop Rapid Foot Screening Ms Chelsea Law, Principal Podiatrist Mr Henry Lee, Podiatrist Ms Ng Jia Lin, Podiatrist Ms Polly Lim, Podiatrist Ms Wong Wan Mun, Podiatrist Mr Yeo Boon

More information

Project I - Background Worksheet. Team Members: Kira Brown, Paige Fallu. Clinical problem Diabetic Foot Ulcers

Project I - Background Worksheet. Team Members: Kira Brown, Paige Fallu. Clinical problem Diabetic Foot Ulcers Project I - Background Worksheet Team Members: Kira Brown, Paige Fallu Clinical problem Diabetic Foot Ulcers 1) Strategic Focus based on the Strategic focus powerpoint presentation and readings a. Team

More information

THE DIABETIC FOOT. Nicola Kilburn Diabetes Specialist Podiatrist

THE DIABETIC FOOT. Nicola Kilburn Diabetes Specialist Podiatrist THE DIABETIC FOOT Nicola Kilburn Diabetes Specialist Podiatrist Diabetic foot disease is associated with significant morbidity and mortality. Foot screening is effective in identifying an individuals risk

More information

Diabetic Foot Services. Ketan Dhatariya Elsie Bertram Diabetes Centre Norfolk & Norwich University Hospital

Diabetic Foot Services. Ketan Dhatariya Elsie Bertram Diabetes Centre Norfolk & Norwich University Hospital Diabetic Foot Services Ketan Dhatariya Elsie Bertram Diabetes Centre Norfolk & Norwich University Hospital Objectives 1. Background 2. Foot Screening 3. First line management ulceration 4. Management

More information

Wound Care Program for Nursing Assistants-

Wound Care Program for Nursing Assistants- Wound Care Program for Nursing Assistants- Wound Cleansing,Types & Presentation Elizabeth DeFeo, RN, WCC, OMS, CWOCN Wound, Ostomy, & Continence Specialist ldefeo@cornerstonevna.org Outline/Agenda At completion

More information

LOOKING AFTER YOUR FEET

LOOKING AFTER YOUR FEET LOOKING AFTER YOUR FEET Looking after your feet Diabetes can affect the nerves and blood supply to the feet. Over years, the nerve endings to the feet can be affected by high blood glucose levels, and

More information

Agenda (45 minutes) Some questions for you. Which wound dressing? Dressing categories/types. Summary

Agenda (45 minutes) Some questions for you. Which wound dressing? Dressing categories/types. Summary Dressing selection Agenda (45 minutes) Some questions for you. Which wound dressing? Dressing categories/types Summary Which wound dressing poster Ref: Which wound dressing? Practice Nursing, September

More information

High Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC

High Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC High Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC A new paradigm? Foot ulceration 101 Assessing Perfusion a new challenge Pressure

More information

A guide to diabetes footcare. Department of Podiatry. patientinformation

A guide to diabetes footcare. Department of Podiatry. patientinformation Department of Podiatry patientinformation Hearing about your experience of our services is very important as it means we can pass compliments to our staff and make improvements where necessary. Tell us

More information

A Pictorial Guide to Diabetic Foot Examinations

A Pictorial Guide to Diabetic Foot Examinations A Pictorial Guide to Diabetic Foot Examinations Author Mike Townson Supported by Foot Screening Competency Screening for the risk of foot ulceration and related complications in people with diabetes can

More information

Diabetes Footcare Pathway from average to excellent

Diabetes Footcare Pathway from average to excellent Thames Valley Strategic Clincal Network Diabetes Footcare Pathway from average to excellent Prepared by the TV SCN Diabetic Foot Reference Group November 2015 Thames Valley Diabetic Footcare Pathway, Version

More information

Oxygen is required for normal cellular

Oxygen is required for normal cellular Article The role of topical oxygen therapy in the management of diabetic foot ulcer s in Scotland: round table recommendations Citation: Stang D, Young M, Wilson D et al (18) The role of topical oxygen

More information

Is there a role for a Vascular Specialist Podiatrist in the diabetes MDfT / FPT?

Is there a role for a Vascular Specialist Podiatrist in the diabetes MDfT / FPT? Is there a role for a Vascular Specialist Podiatrist in the diabetes MDfT / FPT? Martin Fox BSc FFPM RCPS(Glasg) Vascular Specialist Podiatrist North Manchester Leg Circulation Service Pennine Acute Hospitals

More information

Podiatry in Practice. Alan M. Singer, DPM, FACFAS

Podiatry in Practice. Alan M. Singer, DPM, FACFAS Podiatry in Practice Alan M. Singer, DPM, FACFAS Podiatry in Practice Alan Singer, D.P.M. UNIVERSITY PODIATRY GROUP Onychomycosis Anti-fungals Onychocryptosis (Ingrown Nails) Ingrown Nails Partial Nail

More information

Diabetes Foot Care Clinical Pathway Healthcare Provider s Guide

Diabetes Foot Care Clinical Pathway Healthcare Provider s Guide Diabetes Foot Care Clinical Pathway Healthcare Provider s Guide Diabetes, Obesity & Nutrition Strategic Clinical Network Version 1.0 Acknowledgement This healthcare provider s guide has been adapted from

More information

CONNECTIVE ISSUES 2014 Pressure Injury Case Study

CONNECTIVE ISSUES 2014 Pressure Injury Case Study CONNECTIVE ISSUES 2014 Pressure Injury Case Study r1 Outline Medical History Social History Patient Assessment Lower Limb Assessment Factor affecting healing and goals setting Progress of the wound and

More information

Diabetes is a serious disease that can develop from lack of insulin production in the body or due to

Diabetes is a serious disease that can develop from lack of insulin production in the body or due to Page 1 The Diabetic Foot Definition Diabetes is a serious disease that can develop from lack of insulin production in the body or due to the inability of the body's insulin to perform its normal everyday

More information

How to manage leg ulcers in the elderly

How to manage leg ulcers in the elderly How to manage leg ulcers in the elderly David Riding Clinical Research Fellow / Specialty Registrar in Vascular Surgery University of Manchester / MFT British Geriatric Society Trainees Meeting 2018 Objectives

More information

The Triangle of Wound Assessment

The Triangle of Wound Assessment The Triangle of Wound Assessment A simple and holistic framework for wound management CPWSC_TOWA_Brochure_210x210_2018.indd 1 10/01/2018 15.13 ? We asked healthcare professionals around the world about

More information

Failures of the amputation stump during the rehabilitation Peter Farkas M.D., Maria Bakos, Zoltan Dénes M.D. PhD

Failures of the amputation stump during the rehabilitation Peter Farkas M.D., Maria Bakos, Zoltan Dénes M.D. PhD Failures of the amputation stump during the rehabilitation Peter Farkas M.D., Maria Bakos, Zoltan Dénes M.D. PhD National Institute for Medical Rehabilitation, Budapest, Hungary. Ethiology Lower limb amputation:

More information

Bunion (hallux valgus deformity) surgery

Bunion (hallux valgus deformity) surgery Bunion (hallux valgus deformity) surgery Bunion surgery is generally reserved for bunions that are severe and impacting on function. There most frequent surgical procedure used involves a medial incision

More information

Patient Product Information

Patient Product Information Patient Product Information REGEN-D 150 (India's First Recombinant Human Epidermal Growth Factor (rhegf) Gel for Diabetic Foot Ulcers) Generic name: [Recombinant Human Epidermal Growth Factor (rhegf)]

More information

Wound Jeopardy: Name That Wound Session 142 Saturday, September 10 th 2011

Wound Jeopardy: Name That Wound Session 142 Saturday, September 10 th 2011 Initial Wound Care Consult History Physical Examination Detailed examination of the wound Photographs Cultures Procedures TCOM ABI Debridement Management Decisions A Detailed History and Physical (wound)

More information

of :07

of :07 he diabetic foot ulcer - management and outcomes of 6 3-12-2012 11:07 The diabetic foot ulcer - management and outcomes Impaired perfusion Infection Extent and depth Condition of the ulcer Site Sensation

More information

EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists

EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists Nothing To Disclosure DISCLOSURES I have no outside conflicts of interest, financial incentives, or

More information

AGONY FEET. The. of the. Prevention and management of diabetic foot ulcers

AGONY FEET. The. of the. Prevention and management of diabetic foot ulcers The AGONY of the FEET Prevention and management of diabetic foot ulcers By Margaret Falconio-West, BSN, rn, APN/CNS, CWOCN, DAPWCA Nearly 25 percent of people with diabetes will develop a diabetic foot

More information

The challenge for nurses lies in. Controlling exudate and promoting healing of a chronic wound

The challenge for nurses lies in. Controlling exudate and promoting healing of a chronic wound Product FOCUS KEY WORDS Diabetic feet Type 2 diabetes Chronic wounds Dressing selection Benbow M (2011) Dressing awkward wounds. J Comm Nurs 25(6) Clayton W, Elasy TA (2009) A review of the pathophysiology,

More information

Treating your leg ulcer

Treating your leg ulcer Page 1 of 7 Treating your leg ulcer Introduction The information in this leaflet will answer many questions you may have about your leg ulcer. If you have any further questions about your condition or

More information

Introduction. Epidemiology Pathophysiology Classification Treatment

Introduction. Epidemiology Pathophysiology Classification Treatment Diabetic Foot Introduction Epidemiology Pathophysiology Classification Treatment Epidemiology DM largest cause of neuropathy in N.A. 1 million DM patients in Canada Half don t know Foot ulcerations is

More information

MANAGING DIABETIC FOOT ULCERS: BEST PRACTICE

MANAGING DIABETIC FOOT ULCERS: BEST PRACTICE MANAGING DIABETIC FOOT ULCERS: BEST PRACTICE Despite a wealth of evidence and clinical guidelines, the prevention and management of diabetic foot ulcers remains a challenge. This article aims to defi ne

More information

Excision of Morton s Neuroma

Excision of Morton s Neuroma Excision of Morton s Neuroma Day Surgery Unit Patient information leaflet This leaflet outlines the risks, general advice and information about foot surgery called an excision of a Morton s Neuroma. If

More information

a health care guide Care of your high-risk feet

a health care guide Care of your high-risk feet a health care guide Care of your high-risk feet Why is it important? Certain medical conditions for example, diabetes, rheumatoid arthritis and circulation disorders can place your feet at high risk of

More information

Case study: A targeted approach to healing complex wounds using the geko device.

Case study: A targeted approach to healing complex wounds using the geko device. Case study: A targeted approach to healing complex wounds using the geko device. Authors: Mr Sameh Dimitri Consultant Vascular and Endovascular Surgeon MSc FRCS (Eng Edin) Nikki Pavey Physiotherapist at

More information

PRODIGY Quick Reference Guide

PRODIGY Quick Reference Guide PRODIGY Quick Venous leg ulcer infected How do I assess a venous leg ulcer? Chronic venous insufficiency and venous hypertension result from damage to the valves in the veins of the leg and inadequate

More information

ORTHOTICS COMPETENCY FRAMEWORK FOR THE PREVENTION, TREATMENT AND MANAGEMENT OF DIABETIC FOOT DISEASE - 1 -

ORTHOTICS COMPETENCY FRAMEWORK FOR THE PREVENTION, TREATMENT AND MANAGEMENT OF DIABETIC FOOT DISEASE - 1 - ORTHOTICS COMPETENCY FRAMEWORK FOR THE PREVENTION, TREATMENT AND MANAGEMENT OF DIABETIC FOOT DISEASE - 1 - THE ORTHOTICS COMPETENCY FRAMEWORK FOR THE PREVENTION, TREATMENT AND MANAGEMENT OF DIABETIC FOOT

More information

Wound Classification. Overview

Wound Classification. Overview Overview Jeffrey A. Niezgoda, MD FACHM, MAPWCA, CHWS Review of Initial Wound Care Consultation Rational for Classification Wound Appearance Wound Etiology Management Algorithms Initial Wound Care Consult

More information

Root cause analysis of major lower limb amputations in diabetes 2013/14 at County Durham and Darlington Foundation Trust (CDDFT).

Root cause analysis of major lower limb amputations in diabetes 2013/14 at County Durham and Darlington Foundation Trust (CDDFT). Root cause analysis of major lower limb amputations in diabetes 2013/14 at County Durham and Darlington Foundation Trust (CDDFT). By Dr Sara Haq GP Registrar, Durham and Tees Valley Deanery Diabetes Audit

More information

Root Cause Analysis for nontraumatic

Root Cause Analysis for nontraumatic Root Cause Analysis for nontraumatic amputations 2016 (Full Data) Date Richard Leigh and Stella Vig, Co-Chairs London SCN Footcare Network October 2015 Outline of London RCA 2016 London Hospitals invited

More information