The complications of diabetes int he foot are significant and require specialist management. We have an advanced management programme which highlights prevention but provides high quality evidenced based care when the complications occur.
Our Diabetic Foot Prevention Programme includes:
o A detailed history
o Vascular assessment
- Use of specialist Doppler equipment allows us to determine the quality of blood flow to the legs
o Neurological assessment
- Standardised neurological assessment helps to determine the level of sensation present.
o Musculoskeletal assessment
- Identification of underlying deformity and skin tone allow areas of risk to be identified.
o Footwear assessment
- Shoes are a key to preventing problems once there is reduced sensation or blood supply and we will advise accordingly.
o Risk classification
- This information is used to provide an internationally recognised risk classification which guides the level and frequency of assessment and treatment.
o Patient education
- The patient themselves are key to the prevention process. By educating patients on prevention measures, many of the risks of diabetes to feet can be avoided.
- Self monitoring. There is evidence that monitoring skin temperature may reduce the risk of ulceration. In one study, patients who ulcerated had a temperature difference which was 4.8 times greater at the site of ulceration in the week before compared to patients who did not ulcerate. If you are identified as high risk, we can provide you with appropriate equipment and advice to allow home monitoring.
What treatment options are there?
o Specialist insoles:
- We are the first clinic in the UK to offer specialist insoles (based on measured pressure under the foot as well as shape of the foot) that have been shown in scientific studies to reduce the pressure underneath the foot and reduce the re-ulceration rate by 3.4 times compared with insoles that do not include pressure measurement.
- Once a risk has been determined, we:
- Advise on the most appropriate shoes
- Take a reading of the pressures underneath the foot using a special foot pressure platform
- We take a 3 dimensional scan or impression of the foot
- The pressure and shape insole is then produced
- The effectiveness is then checked by using a force sensing insole within the shoe
o Ulcer management
- If there is an active ulcer, we will provide a comprehensive screening and management service. This will include:
- Liaison with your GP / hospital team where required
- Debridement and management of the ulcer
- Investigations such as x-rays, MRI scans and blood test to screen for deeper infection where necessary
- Arrange for antibiotics to manage infection
- Refer for specialist services
- Where appropriate, we can provide surgical management of deformity or infection or arrange referral to an appropriate specialist Diabetes can have devastating consequences on the foot but, after a thorough assessment relatively simple interventions can significantly reduce the risk.