xamine patients' feet to detect risk factors for ulceration. Healthcare professionals should discuss and agree with the patient on a management plan that includes appropriate foot care education to improve knowledge, encourage beneficial self-care, and minimize inadvertent self-harm.
Extra vigilance needs to be used in older people (over 70 years of age) who have had diabetes for a long time, have poor vision, have poor footwear, smoke, are socially deprived, or live alone (Clinical). Special agreements and discussions need to occur between patients and professionals where the patient is housebound or living in a nursing home or some other type of care to ensure equality of access to foot care and treatments. NICE 2003 structured patient education should be made available to all patients with diabetes at the time of their initial diagnosis, and then be require on an ongoing basis depending on assessment of need. Different educational methods should be used until an optimal approach is found to give the desired outcome.
Regular visual inspection of the patients' feet should be done annually, including assessment of foot sensation, and palpation of foot pulses by trained personnel for the detection of risk factors for ulceration (Clinical). Risks should be classified as: low current risk (normal sensation, palpable pulses); at increased risk (neuropathy or absent pulses or other risk factor); at high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer); and ulcerated foot. Examination of patients feet should also include an inspection of any foot deformity and an inspection of the patients' footwear. Self-monitoring and inspection of feet by people with diabetes should be encouraged.
Patients with low current risk of foot ulcers should be encouraged to use beneficial self-care and minimize inadvertent self-harm (Clinical). Healthcare professionals should discuss with patients and agr...