THE ROLE OF THE PODIATRIST IN THE CARE OF THE DIABETIC FOOT
By Zoe Boulton
Contents
Assessment of the diabetic foot Features of ulcerations Debridement Dressings Biomechanics Offloading
General Role of the Podiatrist Identification of patients who are at risk
of developing foot problems Establish a risk score for patient as per
NICE guidelines (Low, Moderate, High) Providing appropriate treatment/
assessment Education to patients and other
professionals Work as part of larger multidisciplinary
team
Vascular assessment
Palpate pulses or use Doppler
Dorsalis Pedis Posterior Tibialis
ABPI
Can be useful in determining level of ischaemia
Carried out when ischaemia is suspected Values of: <0.8: the foot is at risk of
ulceration
<0.5: the foot is critically ischaemic
Caution: May give false readings in diabetic patients due to calcification of arteries consider pallor on elevation and dependant rubor also.
Neurological Assessment
Monofilament 8/10 or below neuropathy
Neurothesiometer
Above 25 volts indicates presence of peripheral
neuropathy
Typical features of Ulceration
Neuropathic Ischaemic
Pulses Bounding Diminished/absent
Pain None/minimal High degree of pain
Location of Ulceration
Pressure areas Borders of feet
Callus Often large amounts Minimal
Assessment of Diabetic Foot
Presence of Infection (bacteria and fungi) Ulceration/ foreign bodies Pre-ulcerative areas Deformity Oedema Skin quality Footwear
Debridement
Sharp debridement Allows true extent of ulcer to be revealed Allows healing with removal of slough
and dead tissue Maggots
Case Study
Patient presented after walking on a gripper rod.
This was also discovered …
Wound Bed
Granulating Sloughly
Dressings
Wound bed Consider patient Exudate management Moist healing environment Negative Pressure dressings Not the be all and end all !!
Biomechanics of foot
Altered foot function can be a cause of ulceration eg hallux limitus.
Forefoot equinus Glycosylation of tissues and amount of
deformity in foot can indicate severity of neuropathy
Offloading
Felt Bespoke insoles and footwear- rocker
soles PRAFO Aircast
Conclusion
Podiatrists work as part of a multidisciplinary team when managing the diabetic foot
The diabetic foot MUST be managed as part of a wide team involving a number of specialities.
We all aim to facilitate healing and ensure the best care for the patient
Thanks for listening