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Module 5.4: Diabetic Foot
Topic Progress:

Topic Two: Stage 2 - The High Risk Foot

The high risk foot

A foot is Stage 2 when it has developed risk factors that can result in ulceration. This is the stage of screening and implementing prevention measures. Patients deemed at risk should be managed by the multidisciplinary team, including the relevant specialists, to prevent the onset of active foot disease.

The diabetic foot enters stage 2 when it has developed one or more of the risk factors for ulceration:

  • Neuropathy
  • Ischaemia
  • Deformity
  • Callus
  • Swelling

This stage is where patients deemed as being high risk should be managed by the foot protection team to prevent onset of active foot disease (Edmonds & Foster, 2014).

MANAGEMENT

Management of the stage 2 foot is achieved through:

  • Mechanical
  • Vascular
  • Metabolic
  • Educational control

Mechanical control

The aim is to protect the foot so as to keep the skin intact and protected from ulceration.

The management of common foot problems such as deformity, callus and dry skin must continue to be treated while providing the patient with skin and nail care advice for the feet (NICE, 2016).

Vascular control

Patients with absent foot pulses should have their ABPI checked (see Module 5.3 Lower Limb Ulcers) to confirm ischaemia. The ABPI should be recorded to allow any deterioration to be monitored.

All diabetic patients with evidence of peripheral vascular disease (PVD) may benefit from antiplatelet agents (Aspirin or Clopidogrel).

If claudication alone is present, then the patient can benefit from exercise (Benbow, 2003).

Patients with severe ischaemia must be referred for a vascular opinion.

Metabolic control

Control of the four major risk factors (hyperglycaemia, hypertension, hyperlipidaemia and smoking) can still help to slow further deterioration of the diabetic foot (McIntosh & Newton, 2006).

Educational control

The patient will continue to require education to enable them to understand how to detect complications at this stage. If they have developed sensory neuropathy, they will have to learn about how to compensate for the lack of protective pain. They have to develop a routine for systematically checking their feet.

Any previously healed ulcerated diabetic ulcers will be classified as Stage 2.