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PodiatryPodiatry S iService
AimsAims O i f di i• Overview of podiatry services
• Assessment criteriaAssessment criteria • Risk Classification• Multidisciplinary working • Questions?Questions?
Podiatry servicesPodiatry servicesW 4 hi l• We cover 4 geographical areas.
• North Tees, Hartlepool, Easington &North Tees, Hartlepool, Easington & Durham Dales24 it• 24 sites
• 35 members of staff
Services offeredServices offeredC P di & P di A i li i• Core Podiatry & Podiatry Assistant clinics
• Diabetic Screening – ‘One Stop Shop’Diabetic Screening One Stop Shop• Biomechanics• High Risk Clinics• Nail SurgeryNail Surgery• Podiatric surgery
Core serviceCore serviceD d i i• Dependency criteria
• Referral pathwaysReferral pathways• Triaging• Risk Classification
Package of care pathways for Podiatry patients
Core service Routine PodiatryCore service – Routine Podiatry
• Packages of care pathways are used within the podiatry dept as a guide forwithin the podiatry dept as a guide for return times and onward referralsThi i f ll i t ith• This is following assessment with dependency criteria decided.
Treatment Assessment and dependency
criteria
Return time guide Onward referrals
criteria
Nail care only (PT) A B C D 4 16 weeks or discharged with
Podiatrist if risk assessment g
advice changed
Acute nails A B C D 1 or 2 Up to 16 weeks Nail surgery Routine care (nails, callus, corns)
A B C D 3 or 6 12 to 16 weeks or discharged with
advice
BiomechanicsPodiatric Surgery
Routine care with additional
A B C D 2 Up to 12 weeks BiomechanicsPodiatric Surgery
requirements (hyperkeratosis, neurovascular corns)High risk ulcerated or potential to ulcer
A 1 Weekly or as required to prevent
OrthotistMulti-disciplinaryor potential to ulcer
patientsrequired to prevent ulceration
Multi-disciplinary team care
Why do we need to screen?Why do we need to screen?
• To identify which patients are at risk• To identify level of risk• To identify level of risk• To enable appropriate care plan to be pp p p
formulated for each patient
‘One Stop Shop’One Stop ShopThe one stop shop provides an opportunity for
i di id l ith di b t t d f t i tindividuals with diabetes to undergo foot screening tohave their risk status classified and receive basic
foot care information by trained health care professionalsfoot care information by trained health care professionals. Patients are classified as:• Low risk• Low risk• Increased risk• High risk High risk• Ulcer/Amputation
How do we classify risk?How do we classify risk?M di l Hi t (MI CVA i l t )• Medical History (MI ,CVA, angioplasty)
• Duration of diabetes & type,yp• Medication• Vascular status• Vascular status • Neurological status• Footwear
Renalproblems
Steroidtherapy
Diabetes
RA Warfarin
py
RA WarfarinRiskfactors
Previousulcers PVD
Chemo-therapy Neuropathy
Low Risk FootLow Risk FootP l• Pulses present
• Sensation intactSensation intact• No ulceration/amputation/angioplasty• No infection• No immunosuppressant condition orNo immunosuppressant condition or
therapy
Increased Risk FootIncreased Risk FootI t F t ( th )• Insensate Foot (neuropathy)
• Absent Pulses (Ischemia)• No Previous Ulcer or Amputation• No Previous angioplasty/Bypass (legs)No Previous angioplasty/Bypass (legs)• Bony Deformity
Ski Ch• Skin Changes
High Risk FootHigh Risk FootN th• Neuropathy
• Absent Pulses• Current/History of Gangrene• Current /History of Ulceration/AmputationCurrent /History of Ulceration/Amputation• History of Angioplasty/Bypass Surgery (legs)
R l I i t• Renal Impairment• Will be seen by High Risk Foot Team ASAP
Circulation of FootCirculation of Foot
Vascular Diabetic
Specialist Podiatrists
consultant
C it
Consultant
Orthotist Community Podiatrist
RadiologistDiabetic Specialist
N
MDT
District &
Nurse
District & PracticeNurses
Podiatry Di ti i
Microbiology
PodiatryAssistants Dieticians
Vascular AssessmentVascular AssessmentP l t (f l ith li ht t h) f th D li• Palpate (feel with light touch) for the Dorsalis Pedis artery both feet. Repeat with Doppler.
• Palpate Posterior Tibial Artery both feet. Doppler.
• I/C indicator of Vascular Health.• Check both feet for any signs of gangreneCheck both feet for any signs of gangrene.• Ask About Previous angioplasty or bypass
InfectionInfection
I f ti d l d d i kl i• Infection can develop and spread very quickly in the diabetic foot.
• If the patient has a compromised vascular status the infection may be masked.
• Look for redness (especially spreading), increased heat locally, malodour (bad smell), y, ( ),discharge (cream, yellow, greenish)
Ulceration with Necrosis.
Charcot NeuroarthropathyCharcot Neuroarthropathy
Ischaemic WoundIschaemic Wound
Neuropathic WoundNeuropathic Wound
Sunset Foot IschaemiaSunset Foot Ischaemia
OsteomyelitisOsteomyelitis