Approximately 50% of patients with diabetes will develop significant peripheral neuropathy and vascular disease, which is a major cause of morbidity and mortality
All patients with diabetes should have a yearly neurovascular examination of their feet
High risk patients should have their feet visualised at each appointment
All patients with diabetes should be advised on basic foot cares including:
Regular self-checks of their feet (daily if high risk)
Always wearing suitable footwear inside and outside the house (can include costs on disability allowance)
Advice on nail cares
Moisturising dry feet (prescribing sorbolene cream often useful)
To notify their care providers if any deterioration in their feet
Prevention and treatment of the diabetic foot also includes:
When using topical capsaicin the patient should be advised:
To use regularly 3-4 times per day + not to massage in
Not to use on broken skin or unintended areas
To wash hands thoroughly after applying
That it takes 1 week to start working and 4-6 weeks before full effects are seen
To build up exposure + that the initial burning sensation will settle
All patients with active foot disease, as below, should be urgently referred to specialist services and should be seen by specialist diabetes foot services with vascular surgery
Foot ulcer (if otherwise well likely able to be seen as outpatient)
Spreading infection
Critical limb ischaemia
Gangrene
Possible active Charcot foot (e.g. hot swollen foot with or without pain)
Deterioration in postoperative tissue/wound
All high-risk patients without active foot disease should be referred to community podiatry including those with:
Previous amputation
Previous ulceration
Consolidated Charcot foot (e.g. deformed foot without swelling and normal temperature)
Or any two of the following
Loss of sensation
Significant callus
Any significant foot deformity
Preulcerative lesion or previous ulceration
eGFR < 15 mL/min
Māori ethnicity
Known peripheral vascular disease (Includes claudication and/or more than one pulse absent)
