Aim and equipment (1/16)
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.
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.
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.
Every patient should be informed of their risk category and have that risk explained to them in accordance with the Diabetic Foot Risk Stratification and Triage Chart. Every patient should be given verbal and written information regarding their risk status.
It is recommended that all Low risk patients are educated in self management, this can be achieved through individual or group educational programmes. Patients of Moderate, High and Active foot disease will receive a treatment and management plan by a podiatrist and will receive updated education at each visit.
It is hoped that following the appropriate risk categorisation with the subsequent introduction of a treatment/management plan that this can minimize and/or help prevent foot problems.
The leaflets above can be downloaded below and from the Links and Resources page.
Diabetic foot risk stratification and triage – summary
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The process of foot screening must lead to the patient being assigned a risk category, and informed of that risk category, with the introduction of a treatment/management plan according to that risk level formulated in consultation with the patient, tailored to suit the patient’s needs (Assessing the risk of developing a diabetic foot problem; NICE: guideline [NG19]: page 15: section 1.3.6).
Foot screening may be carried out by any healthcare professional/worker involved in the care of a patient with diabetes.
It is not important who undertakes the screening process as long as the individual carrying this out has the competence and training to do so and is aware of what action to take depending on the results and the patient’s risk status. This competence can be gained by taking the module test at the end of these modules.
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.
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.