How are you going to manage this patient’s diabetic foot?

1) Assess risk
     - peripheral neuropathy
     - peripheral vascular disease
     - previous ulceration
     - foot deformity
     - poor glycaemic control
     - absence of footcare education
     - low SES

2) Low risk foot
     - General foot care and advice
     - Annual review (use monofilament)

3) “At risk” foot   i.e. neuropathy, absent pulses, or other risk factor
     - multidisciplinary care
     - daily inspection
     - adequate daily moisturing
     - avoidance of detergents and prolonged washing
     - wearing well-fitted shoes
     - regular podiatry care
     - avoid walking barefoot
     - avoid stepping into bath without testing temperature
     - cotton loosefitting socks

4) Ulcer -As above with :
     - Debridement/local wound care/ relief of pressure
     - Close monitoring
     - If hospitalisation required, IV antibiotics/rest.
     - If deep ulcer and cellulitis/osteomyelitis

- evaluate for peripheral vascular disease with ABI - evaluate bone involvement (if bone seen or easily detected by probing OR if ulcer > 3mm and ESR > 40 there is a positive predictive value of >90%)

     - Xray
     - Bone Scan (only really good if negative)
     - MRI (98% sensitivity, 81% specificity, good if planning surgery)