Full Clinical Guidelines - Community First Health Plans.
Full Clinical Guidelines - Community First Health Plans.
Full Clinical Guidelines - Community First Health Plans.
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DIABETIC FOOT CARE/REFERRAL ALGORITHM<br />
Complete Diabetic Foot Exam** (see page 2)<br />
NORMAL (NL) EXAM<br />
NL vasc<br />
NL neuro<br />
NL msk<br />
NL derm<br />
MD/DO/DPM<br />
(or physician extender)<br />
DM FOOT EDUCATION<br />
-patient/family (Diabetes Self-<br />
Management Education)<br />
-verbal/written<br />
-websites<br />
-clinic phone #s<br />
ABBREVIATIONS:<br />
MD = medical doctor<br />
DO = doctor of osteopathy<br />
DPM = doctor of podiatric medicine (Podiatrist)<br />
NL = normal<br />
ABNL = abnormal<br />
ABI = ankle/brachial index<br />
TCPO2 = transcutaneous oxygen pressure<br />
NCV = nerve conduction velocities<br />
PSSD = pressure specified sensory device<br />
REPEAT Diabetic Foot Screen*<br />
-per MD, DO, physician extender visits<br />
or DPM exam<br />
REPEAT EVERY VISIT<br />
ABNORMAL (ABNL)<br />
EXAMS<br />
NORMAL testing-repeat per change in exam<br />
or onset symptoms<br />
A<br />
ABNL VASC<br />
NL neuro<br />
NL msk<br />
NL derm<br />
VASCULAR<br />
CONSULT/TESTING<br />
Consider : PVR, Seg.pres., ABI, TCPO2<br />
-peripheral arteriogram as indicated<br />
-intervention as indicated to re-establish<br />
blood flow<br />
Documentation<br />
of vascular<br />
disease OR<br />
Post intervention<br />
with<br />
improvement<br />
-EDUCATION: signs/symptoms<br />
-HIGH RISK foot status<br />
-Foot screen every MD/DO/DPM,<br />
or physician extender visit<br />
B<br />
NL vasc<br />
ABNL NEURO<br />
NL msk<br />
NL derm<br />
NEURO or PM&R CONSULT<br />
Consider: NCV, PSSD<br />
-other causes: consider and rule out as indicated<br />
-if painful consider<br />
pharmaceutical vs. surgical treatment<br />
-EDUCATION: signs/symptoms<br />
-HIGH RISK foot status<br />
-Foot screen every MD/DO/DPM,<br />
or physician extender visit, PRN<br />
C<br />
NL vasc<br />
NL neuro<br />
ABNL MSK<br />
NL derm<br />
COMPLETE BIOMECHANICAL EXAM<br />
(Podiatrist, Orthopedist)<br />
-discuss clinical significance<br />
-Treatment options: surgical, non-surgical<br />
-EDUCATION: signs/symptoms<br />
-Intervention: surgery→healed = low risk<br />
-Biomech: shoes, orthoses, phys.medicine<br />
-Follow up DPM per modality needed<br />
-Foot screen: every MD/DO/physician<br />
extender visit<br />
D<br />
NL vasc<br />
NL neuro<br />
NL msk<br />
ABNL DERM<br />
Dystrophic (thick,<br />
discolored) toenails<br />
-Debride/reduce<br />
-Culture as needed<br />
-Educate on condition management<br />
-Referral as needed (podiatrist,<br />
dermatologist)<br />
Dry skin, fissures<br />
-Diagnostic tests as indicated, e.g. for fungus<br />
-Topicals as indicated<br />
-referral as indicated<br />
Ingrown toenail<br />
-Instruct on proper nail care<br />
-Matrixectomy if NL vasc exam<br />
Page 3<br />
H EALTH PLANS<br />
www.cfhp.com<br />
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