PodiatryPodiatry S iService

AimsAims O i f di i• Overview of podiatry services

• Assessment criteriaAssessment criteria • Risk Classification• Multidisciplinary working • Questions?Questions?

Podiatry servicesPodiatry servicesW 4 hi l• We cover 4 geographical areas.

• North Tees, Hartlepool, Easington &North Tees, Hartlepool, Easington & Durham Dales24 it• 24 sites

• 35 members of staff

Services offeredServices offeredC P di & P di A i li i• Core Podiatry & Podiatry Assistant clinics

• Diabetic Screening – ‘One Stop Shop’Diabetic Screening One Stop Shop• Biomechanics• High Risk Clinics• Nail SurgeryNail Surgery• Podiatric surgery

Core serviceCore serviceD d i i• Dependency criteria

• Referral pathwaysReferral pathways• Triaging• Risk Classification

Package of care pathways for Podiatry patients

Core service Routine PodiatryCore service – Routine Podiatry

• Packages of care pathways are used within the podiatry dept as a guide forwithin the podiatry dept as a guide for return times and onward referralsThi i f ll i t ith• This is following assessment with dependency criteria decided.

Treatment Assessment and dependency

criteria

Return time guide Onward referrals

criteria

Nail care only (PT) A B C D 4 16 weeks or discharged with

Podiatrist if risk assessment g

advice changed

Acute nails A B C D 1 or 2 Up to 16 weeks Nail surgery Routine care (nails, callus, corns)

A B C D 3 or 6 12 to 16 weeks or discharged with

advice

BiomechanicsPodiatric Surgery

Routine care with additional

A B C D 2 Up to 12 weeks BiomechanicsPodiatric Surgery

requirements (hyperkeratosis, neurovascular corns)High risk ulcerated or potential to ulcer

A 1 Weekly or as required to prevent

OrthotistMulti-disciplinaryor potential to ulcer

patientsrequired to prevent ulceration

Multi-disciplinary team care

Why do we need to screen?Why do we need to screen?

• To identify which patients are at risk• To identify level of risk• To identify level of risk• To enable appropriate care plan to be pp p p

formulated for each patient

‘One Stop Shop’One Stop ShopThe one stop shop provides an opportunity for

i di id l ith di b t t d f t i tindividuals with diabetes to undergo foot screening tohave their risk status classified and receive basic

foot care information by trained health care professionalsfoot care information by trained health care professionals. Patients are classified as:• Low risk• Low risk• Increased risk• High risk High risk• Ulcer/Amputation

How do we classify risk?How do we classify risk?M di l Hi t (MI CVA i l t )• Medical History (MI ,CVA, angioplasty)

• Duration of diabetes & type,yp• Medication• Vascular status• Vascular status • Neurological status• Footwear

Renalproblems

Steroidtherapy

Diabetes

RA Warfarin

py

RA WarfarinRiskfactors

Previousulcers PVD

Chemo-therapy Neuropathy

Low Risk FootLow Risk FootP l• Pulses present

• Sensation intactSensation intact• No ulceration/amputation/angioplasty• No infection• No immunosuppressant condition orNo immunosuppressant condition or

therapy

Increased Risk FootIncreased Risk FootI t F t ( th )• Insensate Foot (neuropathy)

• Absent Pulses (Ischemia)• No Previous Ulcer or Amputation• No Previous angioplasty/Bypass (legs)No Previous angioplasty/Bypass (legs)• Bony Deformity

Ski Ch• Skin Changes

High Risk FootHigh Risk FootN th• Neuropathy

• Absent Pulses• Current/History of Gangrene• Current /History of Ulceration/AmputationCurrent /History of Ulceration/Amputation• History of Angioplasty/Bypass Surgery (legs)

R l I i t• Renal Impairment• Will be seen by High Risk Foot Team ASAP

Circulation of FootCirculation of Foot

Vascular Diabetic

Specialist Podiatrists

consultant

C it

Consultant

Orthotist Community Podiatrist

RadiologistDiabetic Specialist

N

MDT

District &

Nurse

District & PracticeNurses

Podiatry Di ti i

Microbiology

PodiatryAssistants Dieticians

Vascular AssessmentVascular AssessmentP l t (f l ith li ht t h) f th D li• Palpate (feel with light touch) for the Dorsalis Pedis artery both feet. Repeat with Doppler.

• Palpate Posterior Tibial Artery both feet. Doppler.

• I/C indicator of Vascular Health.• Check both feet for any signs of gangreneCheck both feet for any signs of gangrene.• Ask About Previous angioplasty or bypass

InfectionInfection

I f ti d l d d i kl i• Infection can develop and spread very quickly in the diabetic foot.

• If the patient has a compromised vascular status the infection may be masked.

• Look for redness (especially spreading), increased heat locally, malodour (bad smell), y, ( ),discharge (cream, yellow, greenish)

Ulceration with Necrosis.

Charcot NeuroarthropathyCharcot Neuroarthropathy

Ischaemic WoundIschaemic Wound

Neuropathic WoundNeuropathic Wound

Sunset Foot IschaemiaSunset Foot Ischaemia

OsteomyelitisOsteomyelitis