Tayside Diabetes MCN Handbook
Screening and Management of Foot Complications

Patient showing evidence of mild foot deformity with no neuropathy or ischaemia, and whose feet could easily be accommodated in shop bought footwear, should be provided with appropriate footwear advice.

Leaflets providing information as to appropriate footwear for diabetic feet can be issued by orthotic department.

Custom moulded insoles have been proven to reduce areas of high presure by re-distributing it more evenly across the whole plantar surface of the foot.

Patients showing evidence of high pressure, such as callus, on the plantar aspect of the foot, including toes, should be referred to orthotic department for insole assessment.

Patient with prominent metatarsal heads, or reduced fatty padding in this area, should be referred to orthotics for insole assessment.

Patient with evidence of trauma (blistering or bruising) on the plantar aspect of the foot, or those who have a previous ulcer history, should be referred to orthotics for insole assessment.

Footwear and custom moulded insoles have been proven to reduce callus thickness and ulcer recurrence.

Patient showing evidence of foot defomity resulting in high pressure on non-plantar surface of the foot, in particular the dorsum of all toes and the medial and lateral metatarsal joints, and have neuropathy and/or ischaemia should be referred to orthotics for footwear and insole assessment.

There is evidence to support the use of orthoses to increase the healing rate of diabetic foot ulcers.

Patients presenting with ulcers on the plantar or dorsal surface of the foot, the heel or the ankles should be referred to orthotics for formal assessment.

Orthotics will also be accessed via the Diabetes Foot Clinic.

Neuropathic arthropathy, most commonly found in ankle and mid-tarsal joints.

Patients with suspected charcot, warm, painful, inflammed joints with or without deformity, require to be formally assessed for charcot. If it is found to be present, complete rest is required and an immediate referral to a diabetic foot clinic is essential.

The state of the charcot joints, active or non-active, determines the treatment provided.

Active state – Aircast walker® to immobilise the foot and ankle, preventing further deformity.

Non-active state – Custom made insoles and footwear to maintain foot postion and re-distribute plantar pressures.