Module quiz (NHS England)

Introduction

This is the module test for ‘Diabetic Foot Screening’. It is strongly recommended that you work through the learning materials of the module prior to commencing this test. By going straight to the test you may miss out on valuable learning contained within the module. The answers to all the test questions are contained within the module.

Instructions

You will be presented with 6 patient scenarios, based on the information provided for each patient you will be asked to assess whether each patient is Low, Moderate, High or Active foot Disease. You must answer all of these scenarios correctly to obtain a certificate of completion and competence. You will be asked to fill out a form adapted from the Scottish SCI-DC form, however it is not an exact representation of the form and is used purely for learning purposes.

The form is pre populated as if the patient is suffering from no problems and will only need changed if the patient is perceived to be suffering from a problem after carrying out the screening process. The only area which is not pre populated is whether the patient’s pulses are either present or both absent and this must be filled in when vascular screening has been completed.

The highlighted area on the form on the right hand side of the page will correspond to the area of the form which is being completed.

You should allow approximately 20 minutes to complete the test. You should complete this test in one session.


To gain a certificate in the Diabetes Foot Screening, select the test below. You should allow approximately 20 minutes to complete this quiz.

This certificate can be used as evidence of continual professional development (CPD).

05: Additional external resources (optional) (NHS England)

Diabetic foot screening apps

The Society of Chiropodists & Podiatrists

The College of Podiatry, in collaboration with their special advisory group Foot in Diabetes UK and the British Association of Prosthetists and Orthotists, have created two apps to enable increased knowledge around the problems that can occur in the diabetic foot. One is for health care professionals who undertake diabetic foot screenings, the other is for people with diabetes to ensure they are empowered to prevent problems with their feet. Both apps follow NICE (National Institute for Health and Care Excellence) and SIGN (Scottish Intercollegiate Guidelines Network) guidelines.

Diabetic Foot Screening app for Health Care Professionals

The app explains the risk categorisation when conducting a foot screening. Those with diabetes will be categorised as either at low, moderate or high risk of developing a foot ulcer. Full explanations are given as to what this means are given with computerised pictures of the various conditions that can affect those with diabetes.

Diabetic foot screening app

Diabetic Foot Screening app for people with diabetes

The app for people with diabetes will explain what to expect at your annual foot screening, why this is taking place, what the Health Care Professional will do with the results, and what you should come out with and what this means. i.e. your risk category (at low, moderate or high risk of developing a foot ulcer) and verbal and written information with emergency contact details. There will also be information and video clips on footwear advice, self-care, what to look out for.

It also explains how diabetes can affect the feet. It also allows you to track foot screening appointments (offering reminders when they are due).

The app provides detailed, practical information on how to look after your feet, with video clips on footwear advice, self-care, what to look out for.  It allows you to record emergency contact details for your GP, your Podiatrist, etc.

Diabetic foot screening app

The Royal College of Podiatry (RCPod)

04: The procedure (NHS England)

Aim and equipment (1/16)

Aim

The aim of carrying out a foot screening is to identify the presence of risk factors for diabetic foot complications which could lead to ulceration such as – Neuropathy, Peripheral Arterial Disease, Significant structural abnormalities, Significant callus, previous ulceration and the inability to self care.

Equipment

The only piece of equipment that is required to carry out a simple, evidence based, foot screening is a 10g monofilament. The monofilament used should be of good quality such as those manufactured by Bailey Instruments or Owen Mumford and should be used and replaced as per manufacturers instructions to ensure that the monofilament remains accurate. The length of time a monofilament will remain accurate will vary according to it’s frequency of use but Bailey Instruments and Owen Mumford recommend changing the monofilament after approximately 6 months of use. Many clinics use monofilaments much longer than this which can result in less accurate testing. The monafilament should always be replaced if bent.

Monofilament

Neurothesiometer

The Neurothesiometer is a device that tests a patient´s vibration perception threshold (VPT) and monitors diabetic neuropathy by measuring vibration sense. The device graduates in vibration intensity which ranges from 1 – 50 volts.

The Neurothesiometer is not recommended by NICE for use as part of the screening process, but can be useful as part of a more ‘in depth’ assessment in specialist centres.

03: The purpose of foot screening (NHS England)

Introduction

Diabetic foot screening is the cornerstone of good diabetic foot care.

The purpose of diabetic foot screening is to carry out a quick, simple, and evidence based screening to determine at what risk a patient is of developing a diabetic foot ulcer, which may lead to an amputation. The patient should be made aware of their foot risk status and have an appropriate treatment/management plan agreed with the patient and implemented if/when required.

Open diary page

The NICE: Clinical Guideline 19: Diabetic foot problems: prevention and management is produced in the UK by the National Institute of Health and Care Excellence to guide clinicians on the most up to date, and evidence based practice. This guideline will mainly be of interest to all healthcare professionals involved in the care of people with diabetes. The target users are, however, much broader than this, and include people with diabetes, their carers and those who interact with people with diabetes outside of the NHS. It will also be of interest to those planning the delivery of services in England and beyond.

02: Overview of diabetic foot problems (NHS England)

Based on United Kingdom population surveys, diabetic foot problems are a common complication of diabetes with prevalences of;

  • 23-42% for neuropathy
  • 9-23% for vascular disease
  • 5-7% for foot ulceration

Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005 Nov 12;366(9498):1719-24.

Amputation rates are higher in patients with diabetes than patients without diabetes.

Patients with diabetes are at increased risk of developing Peripheral Arterial Disease (PAD), especially when other associated risk factors are present, for example smoking, hypertension and hypercholesterolaemia. Diabetic foot ulceration is principally associated with PAD and peripheral neuropathy, often in combination. Other factors associated with increased risk include;

  • Previous amputation
  • Previous ulceration
  • The presence of significant callus
  • The presence of significant structural abnormality
  • Visual/Mobility problems

01: Overview of diabetes (NHS England)

What is diabetes?

Diabetes mellitus, often simply referred to as diabetes, is a common life – long condition where the amount of glucose in somebody’s blood is too high. This is either because their body does not produce enough insulin, or because cells do not respond to the insulin that is produced, known as insulin resistance.

Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so someone can work, play and generally live their lives. It is vital for life. Insulin is the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel.

People with diabetes cannot make proper use of this glucose so it builds up in the blood and isn’t able to be used as fuel.

Complications may be associated with both low blood sugar and high blood sugar. Low blood sugar may lead to seizures or episodes of unconsciousness (Hypos) and require emergency treatment. High blood sugar may lead to increased tiredness and can also result in long term damage to organs.

When a person has high blood glucose it can produce some of the classical symptoms of diabetes:

  • Frequent urination (polyuria)
  • Increased thirst (polydipsia)
  • Dry mouth
  • Loss of weight
  • Weakness or fatigue
  • Blurred vision

There are two main types of diabetes, Type 1 and Type 2.