| Guidelines 
|
Organization
Effective organization requires systems and guidelines for education, screening, risk reduction, treatment and auditing. Local variations in resources and staffing will often determine the ways in which care is provided. Ideally, a foot-care program should provide:
Foot-care program provisions
- Education of patients, carers and healthcare staff in hospitals, primary healthcare and the community
- A system to detect all patients at risk, with annual foot examination of all known patients
- Measures to reduce risk, e.g. podiatry and appropriate footwear
- Prompt and effective treatment
- Auditing of all aspects of the service, to ensure that actual practice meets standards determined by local implementation of these guidelines
- An overall structure which is designed to meet the needs of patients requiring chronic care, rather than simply responding to acute problems when they occur.
In all countries at least three levels of foot-care management are needed:
| Level 1 |
General practitioner, diabetic nurse and podiatrist |
| Level 2 |
Diabetologist, surgeon (general and/or vascular and/or orthopedic), diabetic nurse and podiatrist |
| Level 3 |
Specialized foot center |
Setting up a multidisciplinary foot-care team has been found to be accompanied by a drop in the number of amputations. If it is not possible to create the full team from the outset, the team should be built up step by step, introducing the various different disciplines at different stages. This team must work in both primary and secondary care settings.
Ideally a foot-care team would consist of a diabetologist, surgeon, podiatrist, orthotist, educator, and plaster technician, in close collaboration with an orthopedic, podiatric and/or vascular surgeon and dermatologist. |
|
|
