Foot Ulceration

Information

Foot ulceration occurs when there is a breakdown in the integrity of the skin. Risk factors associated with foot ulceration include diabetes, peripheral arterial disease, peripheral neuropathy, foot deformity, poorly fitting shoes or a combination of these. In the presence of diabetes, foot ulceration occurs in 5-7% of the population and is associated with poorer outcomes including infection, amputation and increased mortality.

People with foot ulcers are treated and managed by the Podiatry team throughout NHS Lothian. We see patients in community clinics, in the domiciliary setting and at our diabetic foot clinics at the Royal Infirmary of Edinburgh, Western General Hospital and St John’s Hospital, often in partnership with the community nursing teams.

Any person with an ulcer below the ankle should be referred urgently to the Podiatry team. In the presence of diabetes, referrals should be made directly to the Diabetic Foot Clinics. If diabetes is not a risk factor, referrals should be made to the Community Podiatry team.

Who can refer:

GP’s
Consultants and Nursing staff
Individuals can self-refer
Family/friends/carers can make a self-referral on behalf of an individual

Who to refer:

Refer any person with an active foot ulcer urgently

If a person has a limb-threatening or life-threatening diabetic foot problem, refer them immediately to acute services. Examples of limb-threatening and life-threatening diabetic foot problems include the following:

Ulceration with fever or any signs of sepsis.
Ulceration with limb ischaemia (see the NICE guideline on peripheral arterial disease).
Clinical concern that there is a deep-seated soft tissue or bone infection (with or without ulceration).
Gangrene (with or without ulceration)

For all other active diabetic foot problems, refer the person within one working day to the diabetic foot clinic for triage within one further working day