{"id":8391,"date":"2022-07-25T11:53:14","date_gmt":"2022-07-25T10:53:14","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=8391"},"modified":"2025-12-09T13:35:49","modified_gmt":"2025-12-09T13:35:49","slug":"management-of-the-diabetic-foot","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/diabetes\/management-of-the-diabetic-foot\/","title":{"rendered":"Management of the Diabetic Foot"},"content":{"rendered":"\n<p><strong>Information<\/strong><\/p>\n\n\n\n<p>The Diabetic Foot Risk Stratification and Triage Guidelines, published by The Scottish Diabetes Foot Action Group, are used within NHS Lothian to determine the most appropriate management plan. Those seen within the service are managed predominantly in the community podiatry clinics.<\/p>\n\n\n\n<p>New referrals, and complex cases, of active ulceration are managed by our Advanced Diabetes Team at our acute hospital sites at the Royal Infirmary of Edinburgh, Western General Hospital and St John&#8217;s Hospital. The Diabetic Foot Clinics aim to see all new referrals within two working days.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"730\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/management-of-diabetic-foot-2022-1024x730.png\" alt=\"management of diabetic foot 2022\" class=\"wp-image-9006\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/management-of-diabetic-foot-2022-1024x730.png 1024w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/management-of-diabetic-foot-2022-300x214.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/management-of-diabetic-foot-2022-768x548.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/management-of-diabetic-foot-2022.png 1147w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><span class=\"media-credit\">Scottish Diabetic Foot Action Group<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Please only refer those who fall into the following categories:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Moderate Risk \u2013 has at least one risk factor, for example, loss of sensation, signs of peripheral arterial disease, unable to or has no help to self-care or an eGFR &lt;30. Refer to podiatry when first identified as moderate risk for an agreed treatment and management plan to be put in place.<\/li>\n<\/ul>\n\n\n\n<p>This may be a one-off appointment.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>High Risk &#8211; more than one risk factor present.<\/li>\n\n\n\n<li>In Remission \u2013 has had previous ulceration, amputation or a consolidated Charcot joint.<\/li>\n\n\n\n<li>Active foot disease \u2013 has current ulceration.<\/li>\n<\/ul>\n\n\n\n<p>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:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ulceration with fever or any signs of sepsis.<\/li>\n\n\n\n<li>Ulceration with limb ischaemia (see the NICE guideline on peripheral arterial disease).<\/li>\n\n\n\n<li>Clinical concern that there is a deep-seated soft tissue or bone infection (with or without ulceration).<\/li>\n\n\n\n<li>Gangrene (with or without ulceration)<\/li>\n<\/ul>\n\n\n\n<p><strong><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">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<\/mark><\/strong><\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Low risk or newly diagnosed individuals who do not have a podiatric need &#8211; any appropriately trained healthcare professional or clinical support worker can carry out foot screening.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Secondary care HCP&#8217;s can refer using the forms on the Podiatry intranet site&nbsp;<\/li>\n\n\n\n<li>Diabetic Foot Clinic for active ulceration \u2013 SCI Gateway (RIE, WGH or SJH)<\/li>\n\n\n\n<li>Moderate\/High\/In Remission&nbsp;&nbsp;&#8211; Podiatry Community Clinics via SCI Gateway<\/li>\n<\/ul>\n\n\n\n<p><strong><u>Contact Details<\/u><\/strong><\/p>\n\n\n\n<p>Multidisciplinary Foot Team<br>OPD2, Royal Infirmary of Edinburgh<br>Tel: 0131 242 1453<br><a href=\"mailto:Loth.riepodiatrydiabetes@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">Loth.riepodiatrydiabetes@nhs.scot<\/a>\u00a0<\/p>\n\n\n\n<p>Diabetic Foot Clinic, Metabolic Unit<br>Western General Hospital<br>Tel: 0131 537 1297<br><a href=\"mailto:Loth.wghpodiatrydiabetes@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">Loth.wghpodiatrydiabetes@nhs.scot<\/a><\/p>\n\n\n\n<p>Diabetic Foot Clinic<br>OPD1, St John&#8217;s Hospital<br>Tel: 01506 523 175<br><a href=\"mailto:loth.wlpodiatrydiabetes@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.wlpodiatrydiabetes@nhs.scot<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>If infection is suspected in an active foot ulcer at presentation to Primary Care service, please ensure a tissue\/bone sample or swab is obtained prior to prescribing empiric antibiotics.<\/p>\n\n\n\n<p>Any wound should be covered with an appropriate dressing and kept dry until attendance at the podiatry clinic.<\/p>\n\n\n\n<p>See&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/foot-ulceration\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/foot-ulceration\/\" target=\"_blank\" rel=\"noreferrer noopener\">Foot Ulceration<\/a><a href=\"\/refhelp\/guidelines\/FootUlceration\">&nbsp;<\/a>Section<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Training, including an online module, for conducting diabetic foot assessments can be found at&nbsp;<a href=\"http:\/\/www.diabetesframe.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.diabetesframe.org<\/a><\/p>\n\n\n\n<p>Patient&nbsp;information&nbsp;leaflets&nbsp;for&nbsp;risk&nbsp;categories&nbsp;and&nbsp;other&nbsp;specific&nbsp;conditions&nbsp;can&nbsp;be&nbsp;found&nbsp;and&nbsp;downloaded&nbsp;from&nbsp;<a href=\"https:\/\/www.diabetesinscotland.org.uk\/publications\/#leaflet-docs\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.diabetesinscotland.org.uk\/publications\/#leaflet-docs<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=QtQB4chMFQ4\" target=\"_blank\" rel=\"noreferrer noopener\">(327) CPR For Feet &#8211; YouTube<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=xfcavDgDyYE&amp;t=20s\" target=\"_blank\" rel=\"noreferrer noopener\">(327) NHS Scotland SoleSafe Instructional Video &#8211; YouTube<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=FY5kpYULbRI&amp;t=21s\" target=\"_blank\" rel=\"noreferrer noopener\">(327) NHS Scotland HeelSafe Instructional Video &#8211; YouTube<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=J3_T1KWQpoc\" target=\"_blank\" rel=\"noreferrer noopener\">(327) NHS Scotland FootSafe Instructional Video &#8211; YouTube<\/a><\/p>\n\n\n\n<p>SIGN Guideline \u2013 Management of Diabetes:&nbsp;<a href=\"https:\/\/www.sign.ac.uk\/assets\/sign116.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.sign.ac.uk\/assets\/sign116.pdf<\/a><\/p>\n\n\n\n<p>NICE Guideline \u2013 Diabetic Foot Ulcers:&nbsp;<a href=\"https:\/\/www.nice.org.uk\/guidance\/ng19\/chapter\/Recommendations#diabetic-foot-ulcer\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nice.org.uk\/guidance\/ng19\/chapter\/Recommendations#diabetic-foot-ulcer<\/a><\/p>\n\n\n\n<p>NICE Guideline \u2013 Peripheral Arterial Disease:&nbsp;<a href=\"https:\/\/www.nice.org.uk\/Guidance\/CG147\" target=\"_blank\" rel=\"noreferrer noopener\">Overview | Peripheral arterial disease: diagnosis and management | Guidance | NICE<\/a><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Information The Diabetic Foot Risk Stratification and Triage Guidelines, published by The Scottish Diabetes Foot Action Group, are used within NHS Lothian to determine the most appropriate management plan. Those seen within the service are managed predominantly in the community podiatry clinics. New referrals, and complex cases, of active ulceration are managed by our Advanced<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3854,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[718],"class_list":["post-8391","page","type-page","status-publish","hentry","category-management-of-the-diabetic-foot"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/podiatry\/management-of-the-diabetic-foot\/\" rel=\"tag\">Management of the Diabetic Foot<\/a>","rttpg_excerpt":"Information The Diabetic Foot Risk Stratification and Triage Guidelines, published by The Scottish Diabetes Foot Action Group, are used within NHS Lothian to determine the most appropriate management plan. Those seen within the service are managed predominantly in the community podiatry clinics. New referrals, and complex cases, of active ulceration are managed by our Advanced","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8391","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=8391"}],"version-history":[{"count":15,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8391\/revisions"}],"predecessor-version":[{"id":25849,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/8391\/revisions\/25849"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3854"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=8391"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=8391"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}