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

NatioNal best practice aNd evideNce based guideliNes for wouNd maNagemeNt
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Sensory loss. Sensory loss due to diabetic polyneuropathy can be assessed using the techniques set out
in table 8:
Table 8: Assessing neuropathy
Pressure perception
Semmes-Weinstein monofilaments. The risk of
future ulceration can be determined with a 10g
monofilament
Vibration perception 128 Hz tuning fork (hallux)
Discrimination
Pin prick (dorsum of foot, without penetrating
the skin
Tactile sensation Cotton wool (dorsum of foot)
Reflexes Achilles tendon reflexes
Objectives
● Identify the at-risk foot
● Following examination of the foot, each patient can be assigned to a risk category, which should
guide subsequent management. Table 9 identifies the progression of risk categories.
Table 9: Progression of risk categories:
Sensory neuropathy and/or foot deformities or bony prominences and/or signs of peripheral
ischaemia and /or previous ulcer or amputation
Sensory neuropathy
Non-sensory neuropathy
Treatment
In a high-risk patient, callus, and nail and skin pathology should be treated regularly, preferably by a
trained foot care specialist.
Evaluation and education for patients, family and healthcare providers
Education, presented in a structured and organised manner, plays an important role in the prevention
of foot problems. Healthcare professionals involved in the management of diabetic foot disease
should receive periodic education to improve care for high-risk individuals.
Items which should be addressed when instructing the high-risk patient are set out in table 10: