Authors' objectives:

This report provides guidelines on the prevention and management of foot problems in type 2 diabetes.

Authors' recommendations: Key priorities for implementation General management approach - Effective care involves a partnership between patients and professionals, and all decision making should be shared. - Arrange recall and annual review as part of ongoing care. - As part of annual review, trained personnel should examine patients' feet to detect risk factors for ulceration. - Examination of patients feet should include: - testing of foot sensation using a 10 g monofilament or vibration - palpation of foot pulses - inspection of any foot deformity and footwear. - Classify foot risk as: at low current risk; at increased risk; at high risk; ulcerated foot. Care of people at low current risk of foot ulcers (normal sensation, palpable pulses) - Agree a management plan including foot care education with each person. Care of people at increased risk of foot ulcers (neuropathy or absent pulses or other risk factor) - Arrange regular review, 36 monthly, by foot protection team. - At each review: - inspect patients feet - consider need for vascular assessment - evaluate footwear - enhance foot care education. NB If patient has had previous foot ulcer or deformity or skin changes manage as high risk. NICE Guideline Type 2 diabetes: prevention and management of foot problems 5 Care of people at high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer) - Arrange frequent review (13 monthly) by foot protection team. - At each review: - inspect patients feet - consider need for vascular assessment - evaluate and ensure the appropriate provision of - intensified foot care education - specialist footwear and insoles - skin and nail care. - Ensure special arrangements for those people with disabilities or immobility. Care of people with foot care emergencies and foot ulcers - Foot care emergency (new ulceration, swelling, discolouration) - Refer to multidisciplinary foot care team within 24 hours. - Expect that team, as a minimum, to: - investigate and treat vascular insufficiency - initiate and supervise wound management - use dressings and debridement as indicated - use systemic antibiotic therapy for cellulitis or bone infection as indicated - ensure an effective means of distributing foot pressures, including specialist footwear, orthotics and casts - try to achieve optimal glucose levels and control of risk factors for cardiovascular disease

Authors' methods: Clinical guideline

Project Status: Completed

Year Published: 2004

URL for published report: http://publications.nice.org.uk/type-2-diabetes-foot-problems-cg10

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: <p>National Institute for Clinical Excellence (NICE)</p>