Outpatient Diabetes Foot Services

Outpatient Diabetes Foot Services

Diabetes and your Feet

Public Health England estimated that in 2020, the number of people aged 16 years and over with diabetes (diagnosed and undiagnosed) by NHS Wakefield Clinical Commissioning group was equivalent to 25,249 people. This figure is estimated to rise to over 27,000 by the year 2025.

Diabetes can affect many different parts of the body. Some of these changes can be seen in the feet, for example:

Neuropathy (damage to the nerves in the foot as a result of Diabetes): this can lead to loss of protective foot sensation and muscle imbalances in the foot leading to toe deformities such as hammer toes, trigger toes and Charcot foot.

It can also result in reduced sweating which can lead to the development of dry skin.

Peripheral vascular disease: reduced blood flow into the foot can make the foot more vulnerable. Poor blood supply plays a part in ulcer formation and the body’s ability to heal once it has developed. In some cases, this can ultimately lead to amputation and increased mortality.

These are known risk factors which can increase the incidence of foot ulcer formation and delay healing once they have formed.

Explaining diabetic risk categories

Explaining Diabetic Risk Categories

You may have been told by your Podiatrist/ GP/ Practice nurse that you fall into 1 of the 3 categories below:

Red Risk: High risk of developing foot ulceration

Amber Risk: Medium risk of developing foot ulceration

Green Risk: Low risk of developing a foot ulcer in comparison to the general public

FOOT ATTACK -  Ulceration, spreading infection, Gangrene, Rest Pain (pain in the foot at rest or at might that prevents/wakens the patient up from sleep). Suspicion of an acute Charcot arthropathy, or an unexplained hot, red, swollen foot with or without pain

Red Risk

Previous ulceration, previous amputation. On renal replacement therapy, Neuropathy and non-critical limb ischaemia. Neuropathy in combination with callus and/or deformity.

Diabetes Footcare -Red Risk.pdf [pdf] 145KB

Amber Risk

Deformity or Neuropathy or Absent Foot Pulses.

Diabetes footcare - amber risk.pdf [pdf] 142KB

Green Risk

Normal sensation and pulses.

No risk factors except callus alone.

Diabetes footcare - Green risk.pdf [pdf] 140KB

Patients assessed as green risk are monitored by their GP usually through practice nurse run clinics in General Practice for green risk diabetic patients

Amber and Red risk diabetic patients are usually referred on to Local NHS Podiatry services for ongoing assessment/monitoring and treatment if needed.

Following a referral, we provide regular foot examinations in community podiatry clinics for those patients with diabetes at risk of developing foot problems by virtue of previous ulceration, neuropathy (nerve damage) and or peripheral vascular disease (red and amber risk).