Screening of foot in diabetes is an essential part of the examination carried out by the Podiatry Department. The aim of this examination is to determine as early as possible any risk factors for diabetic foot complications such as neuropathy and ischaemia amongst other things, and reduce amputations and ulcerations with timely referrals. Studies have shown that early detection and intervention may prevent up to 85% of amputations in diabetic patients.
It is important to inform the podologist if one is having any problems with their feet such as:
-burning sensation.
-pins and needles.
-problems with corns and nails.
The following should be reported immediately to your caring doctor/podologist:
-open wounds and any ulcers.
-areas of bluish/black skin.
-ingrowing toe nail +/- with discharge.
-colour change – red hot skin which may also be swollen.
-increase in skin foot temperature.
Patients will be risk categorized and if indicated referred for further assessment.
Patient care pathway for screening of patients for Diabetic foot complications.
All patients attending the Diabetes clinics in all the health centres are obliged to have screening for the feet. The nurse leading the diabetes clinic will make sure that the screening actually takes place and the GP refers patient accordingly.
Initial Assessment (Level 1 screening)
All patients will undergo neurological and vascular assessment by the Podiatrists using the mono filament and Doppler ultrasound, The findings are recorded in the specified form DH 140. If initial assessment is certified to be normal then the patient is given a yearly appointment and referred back to the Diabetes Clinic.
Further Assessment (Level 2 screening)
Patients who have gone through level one screening and found to have neuropathic or vascular problems are referred for more in depth screening at Floriana Health Centre. If further tests prove that the foot is not pathologically compromised, it will continue to be followed up at the Floriana Health Centre and expert advice is given to patients. If on the other hand, vascular pathology is confirmed then the patient is referred for level three screening.
Assessment with Vascular Surgeon (Level 3 screening)
Level three screening will be carried out at Mater Dei Hospital in consultation with Vascular Surgeon – Profs K Cassar.
Screening for Diabetic Foot Complications Algorithm
This care pathway has been in place for the past 4 years and a clinical audit has shown that it is effective in identifying early cases of vascular and neuropathic pathology and resulting into early intervention. The quality of life of these patients is thus being greatly improved whilst maintaining good glycaemic control.
1. Comprehensive Diabetes Foot Screening
All Primary Care Health Centres
High risk are referred for further screening
2. Intensive Foot Screening
Floriana Health Centre by trained podiatrists
Ankle Brachial Pressure Index (ABPI), Neuropathy scores, Footwear, Biomechanical examination
Critical/rest pain/ low ABPIs referred for vascular assessment
3. Vascular Assessment
MDH by a trained podiatrist
ABPI, TBI, Doppler waveforms, segmental studies, venous PPG
The Diabetes Foot Examination Form used by the Podiatry Department
