Older people and foot care

This section is focuses on footcare in older people with diabetes:

Introduction

Each year in the UK the number of people with diabetes continues to rise, with around 5,000 people with diabetes undergoing leg, foot or toe amputations, the equivalent to 100 a week (National Institute for Health and Clinical Excellence, 2011). NICE has published 'Diabetic foot problems', a clinical guideline for the care of people with diabetic foot problems in hospital. 

This short clinical guideline aims to provide guidance on the key components of inpatient care of people with diabetic foot problems from hospital admission onwards. NICE suggests the following key priorities for implementation:

  • a multidisciplinary foot care team
  • patient information and support
  • initial examination and assessment
  • care: within 24 hours of a patient with diabetic foot problems being admitted to hospital, or the detection of diabetic foot problems (if the patient is already in hospital)
  • investigation of suspected diabetic foot infection
  • management of diabetic foot infection
  • management of diabetic foot ulcers.

NICE has also published a commissioning guide which provides support for the local implementation of NICE clinical guidelines through commissioning. This resource will help health professionals in England to commission an effective foot care service for adults and children with diabetes mellitus. This commissioning guide should be read in conjunction with the above NICE guidance. View the commissioning guide: Foot care service for people with diabetes.

The NHS Diabetes' commissioning resource has published several commissioning guides for health care professionals including one on foot care services. View: Commissioning diabetes foot care services (PDF 2.4MB) [how to access PDF files].

Nursing Times Learning, in association with NICE has developed a free online unit on diabetic foot problems. The training looks at: common foot problems associated with diabetes and their clinical and wider significance for the patient; why diabetic foot ulcers should be managed by a multidisciplinary specialist foot care team; and the recommended care pathway for patients with diabetic foot ulcers. View the diabetic foot problems resource.

Because of the loss of sensation caused by nerve damage, it is imperative that older patients are taught to look at their feet daily and are aware of who to contact for advice and early treatment. Reduced mobility in older people and failing eyesight can lead to a reduction in the level of foot inspection. Damage can be prevented, but care is needed by the person with diabetes, their carers and healthcare teams, (Diabetes UK, 2010b).

The key issues and case study discuss some of these points further.

References

Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the reference list.