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Every 30 seconds a lower limb is lost somewhere in the world as a consequence of Diabetes. The Lancet Volume 366 Issue 9498. Nice Guideline CG10 Foot care. Recall and annual review to detect risks Exam, Test, Palpate, Inspect, Classify. Annual Screening Review. - PowerPoint PPT Presentation
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Every 30 seconds a lower limb is lost somewhere in
the world as a consequence of Diabetes.
The Lancet Volume 366
Issue 9498
Nice Guideline CG10 Foot care
Recall and annual review to detect risks
Exam, Test, Palpate, Inspect, Classify
How to screen and categorise your patient.
Annual Screening Review
The Diabetic Foot
Peripheral Vascular Disease
Important cause of amputationCausative factor of ulceration in 38-52%50% of all Diabetic amputations (Pacaudet et al 1999)
The Diabetic Foot
Peripheral Neuropathy
• Peripheral neuropathy varies from 12-50%
• Young et al 1993 – 28.5% in 6500 pts• Testaye et al 1996 – 28%• Dyck et al 1993 – 13% symptomatic 50% clinical evidence
The Diabetic Foot
• If can’t feel pressure:- - x10 increased risk of foot ulcer or
amputation• If also foot deformity x32 increased risk Rith Najarian 1992
What do we need to screen a patient?
• Eyes• Hands• 10g Monofilament
Annual Screening review
Annual Screening Review
Examination• Skin Condition• Pulses present• Sensitive to 10g
pressure(loss of 10g = HIGH RISK of ulceration
Symptoms• Claudication• Pain• History of ulcer• Visual impairment• Mobility problems
Inspection• Callus• Deformity• Ulcer
present
Annual Screening Review
Examination• Skin Condition• Pulses present• Sensitive to 10g
pressure(loss of 10g = HIGH RISK of ulceration
Symptoms• Claudication• Pain• History of ulcer• Visual impairment• Mobility problems
Inspection• Callus• Deformity• Ulcer
present
To palpate pulses use 2 fingers not your thumb.Dorsalis Pedis Pulses – can be found in the groove between the 1st and 2nd Metatarsal bonesThis pulse can be absent in 10% of people
Posterior Tibial Pulse – can be found behind the medial malleolus 1/3 of the distance from the medial malleolus to the bottom of the heel, in a hollow.
Annual Screening Review
Avoid areas of callus or ulceration Deteriorates with use Not to test on more than 10 patients with each monofilament per session• Monofilament requires 24hr rest.• Use approved monofilaments either
Bailey’s or Owen Mumford Neuropen
Demonstrate on patients forearm or face to ensure they know how it feels.Ask patient to close their eyes before you start and answer YES each time they feel it. Place the tip of the monofilament on the site to be tested. Apply pressure until it bows. Don’t let it slip or slide across the skin or make repetitive contact with the same spot.Test all sites on the screening form.
Annual Screening Review
Protective sensation intact
(10g monofilament)
Annual Screening Review
Low Risk Normal Flow
Moderate Risk+/- arterial disease
Loss of protective sensation (10g pressure)
• No deformity• No callus• No previous ulcer
Annual Screening Review
High Risk+/- arterial disease
Loss of protective sensation(10g pressure)
• Deformity or callus present
• No previous ulcer
Annual Screening Review
Very High Risk+/- arterial disease
• Ulcer present• Previous ulcer• Loss of protective sensation
(10g pressure)
Annual Screening Review
Arterial Disease• Abnormal flow
• +/- history of claudication
Annual Screening Review
