Remind your patients to contact you or seek emergency help straight away if they notice any of these during their foot check:
- A fissure
- An ulcer
- A scratch
- A cut
- A blister
- Feel pain
In case of a presence of a wound or a blister, cut or scratch it is important to react early and appropriately to avoid serious complications and potential amputation.
Remind your patients what to do if they notice a problem
If they notice something wrong, it is very important to:
- Take the weight off the foot
- Contact you or your nurse as soon as possible
- Go to their nearest emergency centre or clinic if you are not available
It is extremely important to react early and appropriately before the wound gets any worse – no matter how small it is. A minor foot problem for some patients can deteriorate and lead to amputation in a short period of time.
It is very important to remember to avoid weight bearing on the wounded foot or limb (see offloading below).
A key success factor to heal the wound and to avoid complications such as infection, and a potential amputation is to react and respond in time and appropriately.
How to perform an appropriate referral
It is key to refer the diabetic patients with foot ulceration at the right time to the appropriate profession. Here are the international recommendations1 from DFOOT international to know when to refer your patients to specialized settings.
This is the recommended standard of care2 that will be put in place by the multidisciplinary team in a specialised setting.
Reduction of extrinsic and/or intrinsic biomechanical stress/plantar pressure is essential for ulcer protection and healing. The use of non-removable knee-high offloading devices, total contact casts (TCC), removable walkers or specific footwear should be used tailored to individual need and according to local available resources. Patients should be educated to minimise standing and walking. Regular follow-up should be undertaken to ensure clinical effectiveness and compliance.
treatment of infection:
When there are clinical signs of infection, empiric and broad-spectrum antibiotic therapy should be administrated after obtaining microbiological samples (ideally deep tissue), followed by adjustments according to clinical response and microbiological results. Removal of any infected, necrotic or non-viable tissue by trained professionals following comprehensive assessment of infection severity and vascularity is recommended.
metabolic control / holistic management:
Metabolic approach requires optimisation of glycaemic control (if necessary with insulin), the treatment of malnutrition and oedema if present. Optimal management of relevant co-morbidities is mandatory.
restoration of foot perfusion:
In patients with peripheral arterial disease (ankle pressure <50mm Hg, ABI <0.5, toe pressure <30mmHg or Tcp02 <25 mmHg), revascularisation should be considered. When an ulcer does not show signs of healing within 4 weeks, despite optimal management, further vascular assessment and revascularisation should be considered. Diabetic patients sometimes have false positive results of ABI due to the calcification of lower limb arteries.
local wound care:
Frequent ulcer inspection/assessment, debridement and redressings should be undertaken. Dressing selection is based upon ulcer findings (characteristics of wound bed, exudation, size, depth, local pain). In case of neuro-ischemic ulcers, dressings with TLC-NOSF (Lipid-Colloid Technology with Nano-OligoSaccharide Factor) should be considered.
Make sure that your patient gets the appropriate level of care depending on their risk level, even if there is no wound.