Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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2.3 Summary of RecommendationsRecommendations• People with Type 2 diabetes who have peripheral neuropathy should be identifiedbecause they are at risk of foot ulceration and amputation• People with diabetes should be assessed regularly for peripheral vascular disease• People with diabetes who have had a previous amputation are at high risk of ulcerationand further amputation and therefore require regular and frequent review• People with diabetes should be assessed regularly to detect foot deformities including:• Hallux deformities• Hammer or claw toes• Callus• Charcot’s foot• People with diabetes and a current foot ulcer are at high risk for amputation andpreventative interventions to lower that risk should be instituted promptly• People with diabetes and a history of a healed previous diabetic foot ulcer should berecognised as having a life long increased risk of recurrent ulceration and amputation• People with Type 2 diabetes should be routinely assessed with the 10g Semmes-Weinstein monofilament to detect loss of protective foot sensation• People with diabetes should be assessed for peripheral vascular disease by:• enquiring about symptoms of intermittent claudication• palpation of pedal pulses• The routine surveillance for foot problems in people with diabetes should be performedin the following way:• in people without established foot problems, the minimum frequency of footexamination should be once a year• in people with at risk feet but without a current active problem, foot examinationshould be performed every 3 to 6 months• People with diabetes should receive specific footcare education8
• Aim to achieve the best possible glycaemic control in people with Type 2 diabetes inorder to prevent or reduce the development of peripheral neuropathy which is a majorrisk factor for foot ulceration and amputation• People with diabetes should be encouraged to wear properly fitted, cushioned footwearand padded socks• People with diabetes and high risk feet require special attention to footwear• People with diabetes who have foot ulcers or with high risk feet should be cared for by amulti-disciplinary service which should include a physician and podiatrist and haveready access to a specialist nurse, orthotist and surgeon• The cost effectiveness of intensified interventions should be considered in the preventionand management of diabetes foot problems• The influence of socioeconomic factors should be considered in the prevention andmanagement of diabetes foot problems9
Page 1: National Evidence Based Guidelinesf
Page 4: Research OfficersMs Linda SmithPodi
Page 7: 2.2 Issues for Foot Problems in Typ
Page 12 and 13: Background - Peripheral Neuropathy
Page 14 and 15: proportion of subjects with a durat
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Page 20 and 21: Section 2: Diabetes Foot ProblemsIs
Page 22 and 23: predicting risk of amputation, 2.9
Page 24 and 25: Summary - Peripheral Vascular Disea
Page 28 and 29: Evidence - Foot Deformity and Previ
Page 30 and 31: people with both LJM and neuropathy
Page 32 and 33: Summary - Foot Deformity and Previo
Page 36 and 37: Also in the Seattle study, 67 peopl
Page 38 and 39: Summary - Ulcer as a Risk Factor fo
Page 42 and 43: The other frequently reported metho
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Page 46 and 47: Evidence Table: Section 5Detection
Page 48 and 49: Background - Clinical Detection of
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Page 52 and 53: Evidence Table: Section 6AuthorClin
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Section 8: Diabetes Foot ProblemsIs
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Behaviour assessment scores, measur
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Mazzuca et al (1986) studies 532 pe
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with before the programme, after 1-
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Evidence Table: Section 8AuthorEffe
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Background - Glycaemic Control and
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In a previous Japanese randomised s
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Evidence Table: Section 9AuthorGlyc
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Background - Footwear to Reduce Ulc
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period. In addition people without
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Comparisons of in-shoe foot pressur
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The rate of plantar callus formatio
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Evidence Table: Section 10AuthorFoo
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Background - Foot Clinics and Multi
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A prospective non randomised contro
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Summary - Foot Clinics and Multi-di
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Section 12: Diabetes Foot ProblemsI
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and/or osteomyelitis; III - fore-fo
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Summary - Economic consequences•
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Section 13: Diabetes Foot ProblemsI
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Some ethnic groups are associated w
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Evidence Table: Section 13AuthorSoc
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Calle-Pascual AL, Duran A, Diaz A,
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Jannink MJ, van Dijk H, de Vries J,
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Moss SE, Klein R, Klein BE. The 14-
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Soulier SM, Godsey C, Asay ED, Perr
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Diabetes Foot Problems: General Ref
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McNeely MJ, Boyko EJ, Ahroni JH, St
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Diabetes Foot Problems: Other Refer
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Caputo GM, Cavanagh PR, Ulbrecht JS
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Garbalosa JC, Cavanagh PR, Wu G, Ul
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Lavery LA, Armstrong DG, Wunderlich
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Payne C. Regional variations of dia
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Tovi J, Svanborg E, Nilsson BY, Eng
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Criteria used to determine the suit
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QUESTIONS KEY WORDS NO.ARTICLESIDEN
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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