Diabetic Foot Health Service
A department of Foot Health Services, this service has its operating bases at the Norfolk and Norwich University Hospital (working from the Elsie Bertram Diabetes Centre) and at the Queen Elizabeth Hospital, Kings Lynn.
Diabetic foot complications remain the leading cause of all diabetic related hospital admissions. Diabetes is the leading cause of non-traumatic amputation and every 30 seconds a limb is amputated somewhere in the world as a result of diabetes.
The aim of the diabetic foot team is to reduce the number of end stage foot complications which result in increased hospital admissions and ultimately amputation. The team achieves this primarily through direct interventional podiatry. However the service also has a large educational component. The team is actively involved in both formal teaching and clinical placements with the University of East Anglia (UEA). The team has good links with UEA and teaches on both the undergraduate and post graduate nursing programmes. It is an element of the undergraduate medical students' training that they spend time within the diabetic foot clinic shadowing podiatrists.
The team is responsible for carrying out highly specialised interventional podiatry for the management of foot ulceration, gangrene, surgical amputation wounds and Charcot neuroarthropathy across Norfolk. The diabetic foot team forms the apex of a pyramid cascade for the management of the diabetic foot across Norfolk, including Community Podiatry Service.
The podiatrists form an integral part of the multidisciplinary team involved in the management of diabetic foot complications including Consultant Endocrinologists, Vascular Surgeons, Microbiologists and Radiologists.
The main focus of the service is the outpatient management of foot ulceration. 85% of diabetic amputations are preceded by a foot ulcer.
The diabetic foot clinic does not work in isolation; within the clinic we adopt a shared care approach to patient management often with community nurse and/or podiatrists. This ensures that the service concentrates its resources on patients who will benefit most from attending the clinic. With this in mind patients return period is dependent on clinical need and can vary from between 1 – 6 weeks. Emergency appointments are available and podiatrists offer support and advice to community colleagues involved in shared care over the telephone.
The diabetic foot clinic plays a fundamental role in admission avoidance. Primary care practitioners refer patients up to the clinic when they are unsure as to whether the patient needs to be admitted. The podiatrists in clinic will assess and identifying patients who do not need to be admitted and can safely and effectively be managed as outpatients.
The podiatrists are all highly experienced clinicians; as a result they have extended roles and responsibilities. This allows them to develop and deliver highly complex treatment plans, which can include the identification of patients who have critical infection and/or vascular disease and therefore limb threatening complications. It also includes the arrangement of immediate admission through the relevant medical or surgical teams or the direct referral to vascular team for patients with peripheral arterial disease. The management of infection through the recent development of Patient Group Direction (PGD) for the supply of antibiotics is also offered at the NNUH. We aim to ensure prompt and appropriate treatment with the aim of reducing unnecessary admissions which often result from ineffective treatment.
Podiatrists work closely alongside other members of the multidisciplinary team arranging and authorising microbiological and radiological investigations as appropriate. They have excellent links with the plaster technicians in the orthopaedic department of the NNUH and QEH which allows the manufacture of Total Contact Cast (TCC) for the treatment of foot ulceration and Charcot. We offer the provision of a variety of pressure relieving equipment including Aircast Walkers, DH pressure shoes and boots.
The foot clinics at NNUH and QEH are one of the few diabetic centres regionally to have access to computerised in-shoe pressure measurement system (F-Scan).This is essential in the development and manufacture of foot orthotics to aid healing and reduce future ulceration. The service offers control and authorisation of the provision of hospital footwear which is essential in preventing the development of new or further ulceration in the diabetic population. The team are frequently involved in the joint assessment of patients on an individual basis or through specific clinics.
The team also undertakes outreach clinics for patients who have extremely high-risk feet with a history of foot ulceration or amputation. The re-ulceration rate among diabetic patients is high. The aim of these sessions is to reduce the risk of patients developing further complications.
The podiatrists act as a resource for primary care practitioners treating the diabetic foot. They provide telephone advice as necessary on a variety of topics including answering questions on what, when and who requires hospital admission, and arranging this as necessary, the management of infection including the use of first and second line antibiotic therapy, the appropriate choice of dressing and the management of neuropathic pain.
Who this Service is for
The service treats all diabetic patients with active foot ulceration and gangrene. It is also involved in the postoperative follow up of patients who have undergone amputation. Referrals are accepted from all disciplines across both Primary and Secondary care.
The service also accepts referrals from other neighbouring hospitals providing specialist input into the management of extremely complicated foot ulceration, which falls outside the capabilities of local practitioners.
In addition the service accepts referrals for NNUH and QEH in-patients with diabetic foot complications, directly intervening as necessary and offering advice on referral and management decisions.
LocationThe clinical bases for the Diabetic Foot Service are at the Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital (NNUH) and at Queen Elizabeth Hospital (QEH), Kings Lynn. How to Find UsSources of ReferralGPs, consultants, District Nurses, Community Podiatrists, Practice Nurses and other Health Professionals. Referral Contact NumberNNUH (01603 288522) and QEH (01553 613613) |
Hours of ServiceThe service operates 8.30 – 5.00 Monday - Friday |