National best practice and evidence based guidelines for wound ...

3.5 Guidelines for the prevention and management of Diabetic foot ulceration
Introduction
The basic principles of prevention and management of diabetic foot ulceration described here are based
on the international consensus and practical guidelines on the management and prevention of
the diabetic foot (IWGDF 2007). They are aimed at health care workers involved in the care of people
with diabetes. It should be noted that the full set of guidelines are available through the International
Working Group on Diabetic Foot (www.iwgdf.org).
This section is divided into two distinct parts:
Part A deals with the non-ulcerated limb
Part B deals with the ulcerated limb
This consensus identifies 5 key elements which underpin foot management:
Table 6: Key elements in DF management
1 Regular inspection and examination of the at-risk foot
2 Identification of the at-risk foot
3 Education of patient, family and healthcare providers
4 Appropriate footwear
5 Treatment of non-ulcerative pathology
Part A: the non-ulcerated limb
Assessment
All people with diabetes should be examined at least once a year for potential foot problems. Patients
with demonstrated risk factor(s) should be examined more often – every 1 -6 months (see tables 7,8,9).
The patient’s feet should be examined with the patient lying down and standing up, and their shoes and
socks should be inspected.
History and Examination should include items in table 7:
Table 7: History and Examination
History
Previous ulcer/amputation, previous foot education, social isolation, poor access to
healthcare, bare-foot walking
Neuropathy Symptoms, such as tingling or pain in the lower limb, especially at night
Vascular status Claudication, rest pain, pedal pulses
Skin Colour, temperature, oedema
Bone/Joint Deformities (eg claw toes, hammer toes) or bony prominences
Footwear / socks Assessment of both inside and outside
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