<html> <head> <meta charset="UTF-8"/> <meta name="tikaGenerated" content="true"/> <meta name="date" content="2021-11-03T03:34:10Z"/> <meta name="xmp:CreatorTool" content="Adobe InDesign 16.3 (Macintosh)"/> <meta name="trapped" content="False"/> <meta name="meta:creation-date" content="2021-10-26T03:56:57Z"/> <meta name="created" content="Tue Oct 26 14:26:57 ACDT 2021"/> <meta name="xmpTPg:NPages" content="2"/> <meta name="Creation-Date" content="2021-10-26T03:56:57Z"/> <meta name="dcterms:created" content="2021-10-26T03:56:57Z"/> <meta name="Last-Modified" content="2021-11-03T03:34:10Z"/> <meta name="dcterms:modified" content="2021-11-03T03:34:10Z"/> <meta name="Last-Save-Date" content="2021-11-03T03:34:10Z"/> <meta name="meta:save-date" content="2021-11-03T03:34:10Z"/> <meta name="producer" content="Adobe PDF Library 15.0"/> <meta name="modified" content="2021-11-03T03:34:10Z"/> <meta name="Content-Type" content="application/pdf"/> </head> <body> <pre> Southern Adelaide Local Health Network (SALHN) Diabetes Foot Care Pathway SA Health Active Foot Disease Pathway Diabetes Foot Care Pathway Southern Adelaide Local Health Network (SALHN) Aboriginal and Torres Strait Islander peoples are recognised as a high risk group for foot ulceration and amputation. Aboriginal Health Workers/Practitioners are part of our HRFS to provide holistic and culturally safe care. Chronic Limb threatening Ischaemia Acute Limb Ischaemia Charcot Foot Foot Ulcer Same day referral to SALHN HRFS for wound care and o?oading (pressure management) Refer to Practice Points overleaf to implement standard of care Initiate appropriate antibiotic therapy and collection of microbiology specimens For any queries please call the High Risk Foot Co-Ordinator on: 0403 937 758 Severe infection Foot infection associated with systemic features (SIRS) Clinical signs of in?ammation (redness, heat, swelling) present in the neuropathic foot. Pain may be present despite neuropathy. No evidence of a portal of entry (i.e. ulcer) to suggest infection. Sudden Acute Foot Pain, Pallor or coldness present over hours or days and non-palpable foot pulses Refer immediately to FMC ED Same day referral to a vascular specialist or call the Vascular Registrar at FMC via switch: Ph: (08) 8204 5511 PAD with either: Pain on rest Gangrene Lower-limb ulceration Infection present without systemic signs or symptoms Mild infection - <2cm erythema periwound involving skin & subcutaneous tissue Moderate infection - >2cm erythema periwound involving deeper structures (i.e. tendon/bone) Ulcer deep to tendon/joint/bone Refer immediately to FMC ED Action PlanPresentation Active Foot Disease No infection in a super?cial ulcer Same day referral to SALHN HRFS Refer to O?oading in Practice Points overleaf to implement standard of care. Southern Adelaide Local Health Network High Risk Foot Service High Risk Foot Coordinator Ph: 0403 937 758 (Mon to Fri 0830 1630) After hours refer to FMC ED Send all referrals to Podiatry Department: Ph: 8204 4884 Fax: (08) 8204 5020 email: Health.SALHNPodiatry@sa.gov.au If not greater than 50% reduction by 2-4 weeks, refer to SALHN HRFS Refer to Practice Points overleaf to implement standard of care. Aboriginal and Torres Strait Islander peoples are recognised as a high risk group for foot ulceration and amputation. Aboriginal Health Workers/Practitioners are part of our HRFS to provide holistic and culturally safe care. Active Foot Disease Pathway Southern Adelaide Local Health Network High Risk Foot Service High Risk Foot Coordinator Ph: 0403 937 758 (Mon to Fri 0830 1630) After hours refer to FMC ED Send all referrals to Podiatry Department: Ph: 8204 4884 Fax: (08) 8204 5020 email: Health.SALHNPodiatry@sa.gov.au Southern Adelaide Local Health Network (SALHN) Diabetes Foot Care Pathway Active Foot Disease Pathway Southern Adelaide Local Health Network High Risk Foot Service High Risk Foot Coordinator Ph: 0403 937 758 (Mon to Fri 0830 1630) After hours refer to FMC ED Send all referrals to Podiatry Department: Ph: 8204 4884 Fax: (08) 8204 5020 email: Health.SALHNPodiatry@sa.gov.au SA Health Active Foot Disease Pathway ED: Emergency department FMC: Flinders Medical Centre NH: Noarlunga Hospital HRFS: High Risk Foot Service LOPS: Loss of Protective Sensation PAD: Peripheral Artery Disease SINBAD: Site (Ulcer), Ischaemia, Neuropathy (LOPS), Bacterial infection, Area, Depth SIRS: Systemic In?ammatory Response Syndrome (refer to local guidelines) High Risk Foot Service: The SALHN High Risk Foot Service comprises of clinics at multiple sites to provide best practice care. These include, FMC, NH and Marion GP Plus. Clinics include: The interdisciplinary foot clinic consisting of Podiatry, Vascular Surgery, Endocrinology, Infectious Diseases, Orthopaedic Surgery, Dietetics, Orthotics and Prosthetics, Aboriginal Health, Medical Illustration, Diabetes Nurse Educator. Podiatry/Orthopaedic clinic Nail surgery clinic Podiatry Outpatient clinics Co-morbidities: The presence of one or more additional conditions co-occurring with a primary disease. While many people with diabetes + foot infection may not require hospitalisation, comorbidities, such as renal failure or an immunocompromised state, may require an admission. International Working Group Diabetic Foot Guidelines 2019: https://iwgdfguidelines.org/guidelines/guidelines/ Identi?cation and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes) 2011. Melbourne Australia Diabetic foot problems: prevention and management NICE guideline (NG19): https://www.nice.org.uk/guidance/NG19 D-Foot International fast track pathway: https://d-foot.org/projects/fast-track-pathway-for-diabetic-foot-ulceration NADC Collaborative Interdisciplinary Diabetes HRFS Standards 2018: https://nadc.net.au/wp- content/uploads/2019/07/HRFS-Standards-FINAL-9.7.18.pdf O?oading the ulcer or charcot foot, consider immobilising the a?ected leg with knee-high cast/boot and/or wound care. Discuss options with local HRFS Address infection if present Score ulcer (use SINBAD plus other classi?cation system as appropriate) to assess progress and facilitate faster triage Local wound care: sharp debridement and ulcer dressing to absorb exudate Optimise perfusion, diabetes holistic management and modi?able risk factors Practice Points Diabetes Foot Care Pathway Southern Adelaide Local Health Network (SALHN) References Southern Adelaide Local Health Network High Risk Foot Service High Risk Foot Coordinator Ph: 0403 937 758 (Mon to Fri 0830 - 1630) - after hours refer to FMC ED Send all referrals to Podiatry Department: Ph: 8204 4884 Fax: (08) 8204 5020 email:Health.SALHNPodiatry@sa.gov.au Definitions Abbreviations </pre> </body> </html>