Frimley Guidelines

ED and Inpatient Diabetic Foot Pathway

Key Points

  • People with Diabetes should have their feet examined on admission, regardless of the presenting complaint, with the outcome recorded on Epic EPR.

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Abbreviations

DVTDeep Vein Thrombosis
I&DIncision and Drainage
MDFTMultidisciplinary Diabetic Foot Team
PVDPeripheral Vascular Disease

For All Patients

Inform the MDFT about an admission. To do this submit a Podiatry referral via Epic.

Wexham Park Hospital

There is a Hot Foot Phoneline available via switchboard for Healthcare Professionals 9am to 5pm every day.

Minimum assessment

Check

• Foot pulses, Sensation, Skin integrity

• Capillary glucose

• FBC, CRP, eGFR, Creatinine, HbA1c (nb CRP may not be raised even with severe infection)

• Blood culture & Deep swab

• Plain X-ray foot 3 views: AP, Oblique and True Lateral (look for gas, foreign body, osteomyelitis, missed fracture)

*Start Antibiotics if clinically indicated

• The infected diabetic foot can deteriorate rapidly

• Prescribe antibiotics promptly according to Eolas guidelines (local trust micro guidelines) Patient leaflet

Vascular Pathway

Discuss with Vascular Reg/Consultant on call at FPH immediately.

Patient could deteriorate rapidly & need urgent transfer from Wexham.

Orthopaedic Pathway

Refer to on-call T&O for management of Foot Attack

• Pulses palpable & no other evidence of PVD

• Urgent I&D within 24 hours

• Antibiotics*

• Consider MRI Foot & Ankle

Possible Foot Ulcer

Refer to Medics, treat as severe infection

• Antibiotics* • X-Ray • Notify MDFT (as below)

Patient leaflet

Possible Charcot Foot

MDFT Referral

  • Strict non weight bearing

  • Plaster room: Diabetic Vacoped Boot / Total Contact Cast

  • Refer to Foot & Ankle Fellow or Consultant for a plan (Ortho Reg on-call out of hours)

Patient leaflet