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 Borders. We see patients in community clinics, in the domiciliary setting (housebound/bedbound only), and at our diabetic foot clinic at Borders General Hospital. Treatment may be undertaken in partnership with the community nursing teams.

Who to refer, who not to refer, how to refer

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 podiatry team for triage – the podiatry team will triage to either community podiatry or the diabetic foot clinic, depending on situation/patient history. Please provide as much information as possible on the referral to assist triage.

Who Not to Refer

Those with leg ulceration/ ulceration above ankle level

How to Refer

Refer via SCI Gateway or ask patient to complete self-referral form here: podiatry-self-referral.docx (live.com)

Primary care management

Complicating factors of foot ulceration that can be addressed in primary care:

Poorly controlled diabetes
Smoking
High cholesterol
High blood pressure
Being overweight/ weight management
Sedentary lifestyle

If infection is suspected in an active foot ulcer at first presentation whether in primary care or hospital setting, please ensure a tissue/bone sample or swab is obtained prior to prescribing empiric antibiotics.

Any wound should be covered with an appropriate dressing and kept dry until attendance at the podiatry clinic.

Links to the Ropper Ladder Guidelines for managing infected wounds is in the Resources and Links section.

Pressure relief of the affected area is essential. This should be maximised at presentation by use of changes to footwear, and if needed issue of temporary footwear e.g. Kerraped shoe, or non-weightbearing pressure relief e.g. Prolevo FootSafe Prevention Boot.