Diabetes is a condition with far-reaching consequences. As the population ages, more diabetes-related conditions will occur.
Diabetes is the root cause of the majority of non-traumatic limb amputations, and therefore diabetic foot problems need to be treated as an emergency, according to NICE guidelines.
Diabetic foot problems can include neuropathy, charcot arthropathy (or other deformity), gangrene, ulcers, osteomyelitis, peripheral arterial disease, or infection.
For care of diabetic foot problesm, the multidisciplinary team in an acute setting will comprise: tissue viability nurse, diabetologist, relevant surgeon, diabetes specialist nurse, podiatrist, and possibly a physiotherapist. The aim of the MDT is primarily mobilisation.
Patients with diabetes-related foot problems need to be referred to the responsible MDT within 24 hours of admission. this team will then assess and initiate treatment of the patient’s underlying diabetes, assess and coordinate care for the presenting foot problems, (the assessment is to include a vascular assessment). Infection also needs to be treated immediately; a swab may be taken, but depending on the stage of infection, it is likely that antibiotics are started before results return from the lab. At this point the patient will be assessed with regard to their need for orthotics or other interventions to protect the feet and revent/reduce future problems where possible. The MDT will also begin to consider discharge, so there is a workable plan in place at the right time.
At all stages, the patient must be kept in the loop with discussions and must be a part of the decision-making process. Patient education and empowerment is paramount, as is effective communication with the primary care team taking over care (if necessary).