Neobook — clinical reference

At diagnosis and annually thereafter a trained healthcare worker (nurse, doctor, community health worker) must examine patient’s feet without socks or bandages to determine risk status:

Inspect for foot deformities, and skin and nail abnormalities

Inspect footwear
Test sensation (monofilament, 128 Hz tuning fork or “touch the toe”)
Palpate dorsalis pedis and posterior tibial pulses

Training of HCW should be done by diabetes specialists, podiatrists or specialist nurses

Clinical Findings	Clinical Findings	Clinical Findings	Clinical Findings
No previous ulcer or amputation No deformities Normal sensation No PAD	Any one of: Foot deformity Loss of sensation PAD	Previous ulcer or amputation, or 2 or more of: Foot deformity Loss of sensation PAD Visually impaired On renal replacement	Any of: Active foot ulcer Gangrene Spreading infection Critical limb ischaemia Charcot foot
Low Risk	Moderate Risk	High Risk	Active Foot Disease
Management Structured foot care education Annual foot screen in primary care	Management Ongoing education in foot protection Foot examination at every clinic visit Vascular, podiatry, orthotics, diabetes specialist referral as needed	Management Ongoing education in foot protection Foot examination at every visit Multi-disciplinary referral within 1 month, co-ordinated by senior diabetes consultant	Management Ongoing education in foot protection Foot examination at every visit Multi-disciplinary referral within 24 hours, co-ordinated by senior diabetes consultant

Management for all patients

Structured patient education
Control of glycaemia, blood pressure, dyslipidaemia and obesity

PAD: Peripheral arterial disease i.e. both pulses absent in at least one foot, or other signs and symptoms (claudication, pallor, dependent rubor, reduced venous filling, poor skin and tissue vitality).
1. Adapted from National Diabetes Programme, Clinical Strategy and Programmes Directorate. Model of Care for the Diabetic Foot (Ireland). 2014 available at http://www.hse.ie/eng/about/Who/clinical/natclinprog/diabetesprogramme/modelofcarediabetes.pdf (Accessed 21 December 2016)