Diabetes Podiatry Service
Diabetes is a long term condition that can cause foot problems. Some of the problems can occur because the nerves and the blood vessels supplying the feet are damaged. This can result in peripheral neuropathy, which will affect the feeling in feet and ischaemia, causing poor circulation.
These changes can be very gradual and can go unnoticed during the early stages. Screening for foot problems takes place in community annually. The risk of developing ulceration is assessed and categorised as low, increased or high risk depending on the results of screening.
Patients with diabetes should check their feet daily to look for any potential problems. If the foot checks reveal any problems such as breaks in the skin, sudden swelling or change in colour (red, white or blue) they should contact their podiatrist or GP surgery for advice. See link to video for Diabetic Foot Screening.
Please refer to the Diabetic Foot Referral Pathway below:
- Having diabetes, without any complications such as loss of sensation or reduced circulation to the feet, does not necessarily make you high risk.
- Around 15% of all people with diabetes will develop an ulcer at some point.
- More than half of all non-traumatic lower limb amputations are carried out on patients with diabetes.
Harrogate & District NHS Trust provides a Podiatry Service to the population of North Yorkshire which includes Selby and York. We serve the largest geographical area of any Podiatry Department in England covering 3200 square miles and a population of 775,000.
The service to patients with diabetes is provided in both community clinics and in the centre for diabetes and endocrinology at York Hospital.
Accessing the service
Podiatry accepts referrals by letter from any GP or Health Care Professional. We prioritise non-urgent patients according to the information given in the referral letter and offer appointments in a local clinic. Waiting times vary at different clinics according to need.
Community Referrals should be addressed to the Podiatry Department at White Cross Court. Tel 01423 542300
The aim of Community Podiatry is to keep people mobile, reduce pain and discomfort and to prevent any further deterioration in the foot condition.
Home visits are limited for those patients who are housebound. Wherever, possible it is best for patients to attend a clinic as we can offer a better level of service in a fully equipped podiatry surgery.Assessment for eligibility for Home Visits are made by the podiatrist on initial treatment.
This service is for people who have foot ulcerations or who have been assessed as being at high risk of ulceration. Patients with acute problems/ulceration will be offered an appointment within 24 working hours of receipt of referral. There is an open door policy for rapid access for any patient with diabetes and an acute foot problem, injury or wound which includes self-referral. We encourage all Health Care Professionals to urgently access the service for any patients with acute foot problems or ulceration by telephone 01423 542300 or 01904 726510.
The aim of this service is to help wounds to heal, prevent deterioration and avoid amputation. The podiatry team liaises closely with the medical and surgical teams in the hospital to ensure that all treatments which can help wound healing are accessed when needed. These may include for example, blood sugar management by the diabetologist or specialist nurse and other interventions, such as vascular surgery to improve the circulation. There is a Multidisciplinary Team clinic each week for joint review of our most complex at risk patients. There is usually an intensive course of podiatry treatment with frequent appointments for cleaning, debriding and dressing wounds.
Avoiding infection is of great importance and advice on caring for the wounds will be given, using community nursing support where needed. Treating infection is taken very seriously and is guided by the microbiologists. Temporary footwear, boots or casts may sometimes be used to offload or protect the area where the ulcer has developed. Insoles and custom made inlays may be made by the podiatrists or orthotist. When the wounds have improved, follow up appointments are arranged at community clinics with podiatrists who have the skills to recognise any potential deterioration which may require further treatment in the specialist clinics.
We prioritise patients with diabetes in accordance with NICE guidance.
Please see NICE algorithm and guidelines on assessing risk if unsure Diabetic foot problems: prevention and management (nice.org.uk)
For more information visit the podiatry site on the HDFT website