High risk

Definition

Previous ulceration or previous amputation or on renal replacement therapy

Neuropathy and non-critical limb ischaemia together

Neuropathy in combination with callus and or deformity or non-critical limb ischaemia in combination with callus or deformity.

Action

Tell people that they are at high risk of foot ulceration and refer to the foot protection service for first assessment (within 2-4 weeks).

The foot protection service should; assess the feet and give advice and care (as detailed below), frequently (1-2 months) or very frequently (1-2 weeks) where there is immediate concern.

The foot protection service will assess foot biomechanics, give footwear advice and consider providing Insoles and speciality footwear. Assess lower limb vascular status. Liaise with other healthcare professionals about diabetes management and reducing the risk of cardiovascular disease.

People in hospital should be given a device to offload heel pressure.