A diabetes foot action plan was introduced to Scotland in 2006. This has included developing a foot-screening programme with foot risk stratification. Currently 140,000 people (61% of all patients with diabetes) have undergone foot risk stratification, with 69% categorised as low risk, 20% as moderate risk and 11% as being at high risk of foot ulceration. This has helped support the introduction of needs-related care pathways. Schemes to support community-based podiatrists and strengthen links and referral pathways to specialist foot services have been introduced. Identifying key competencies for podiatrists and orthotists working for patients with diabetes has underpinned the development of a competency framework for each profession. Nationally agreed and utilised patient education leaflets and staff education programmes, including online training programmes have been introduced. Surveys of multidisciplinary foot services, have shown amongst other things, a low level of consultant involvement in such clinics (58% of Health Boards). Overall, national data indicated that across Scotland in 2009 the prevalence of foot ulceration was 2.5% in December 2010 and amputation was 0.5% in 2009, the latter having declined from 0.8% in 2003.
Scottish Intercollegiate Guidelines Network (SIGN). SIGN guideline on diabetes. SIGN, 2010. www.sign.ac.uk/pdf/sign116.pdf (accessed December 2010).
3.
National Institute for Health and Clinical Excellence (NICE).NICE guidance on type-2 diabetes: foot care. London, NICE, 2004. www.nice.org.uk/nicemedia/live/10934/29242/29242.pdf (accessed December 2010).
4.
National Institute for Health and Clinical Excellence (NICE).Diabetic foot problems. In Patient Management of Diabetic Foot Problems. March. London, NICE , 2011. www.nice.org.uk/nicemedia/live/13416/53556/53556.pdf (accessed March 2011).
5.
Abbott CA, Carrington AL, Ashe H. et al. The North West Diabetes Care Foot study: incidence of, risk factors for, new diabetic foot ulceration in a community-based cohort. Diabet Med2002;19:377-84.
6.
Leese GP, Reid F., Green V. et al. Predicting foot ulceration in diabetes: validation of a clinical tool in a population-based study. Int J Clin Prac2006;60:541-5.
7.
Leese GP, Schofield CJ, McMurray B. et al. Scottish foot ulcer risk score predicts healing in a regional specialist foot clinic. Diabetes Care2007; 30:2064-9.
8.
International Diabetes Federation.International concensus on the diabetic foot. Five cornerstones, identification of the foot at risk. 2007. www.iwgdf.org/index.php?option=com_content&task=view&id=39&Itemid=60 (accessed February 2009).
9.
Peters EJ, Lavery LAEffectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes Care2001;24:1442-7.
10.
Boyko EJ, Ahoroni JH, Cohen V. et al. Prediction of diabetic foot ulcer occurrence using commonly available clinical information. Diabetes Care2006;29:1202-07.
11.
Boyko EJ, Ahoroni JH, Stensel V. et al. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes Care1999;22:1036-42.
12.
Edmonds ME, Blundell MP, Morris ME et al. Improved survival of the diabetic foot: the role of a specialized foot clinic. Q J Med1986;60: 763-71.
13.
Larsson J., Apelqvist J., Agardh CD, Stenström A.Decreasing incidence of major amputation in diabetic patients: a consequence of a multidisciplinary foot care team approach?Diabet Med1995;12:770-6.
14.
Faglia E., Favales F., Aldeghi A. et al. Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation. J Diabetes Complications1998;12:96-102.
15.
Laing PW, Cogley DI, Klenerman L.Neuropathic foot ulceration treated by total contact casts. J Bone Joint Surg Br1992;74:133-6.
16.
Myerson M., Papa J., Eaton K., Wilson K.The total-contact cast for management of neuropathic plantar ulceration of the foot. J Bone Joint Surg Am1992;74:261-9.
17.
Armstrong DG , Lavery LA, Wu S., Boulton AJM.Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: A randomized controlled trial. Diabetes Care2005;28:551-4.
18.
Lavery LA, Armstrong DG, Murdoch DP et al. Validation of the infectious diseases society of America’s diabetic foot infection classification system. Clin Infect Dis2007;44:562-5.
19.
Leese GP, Nathwani D., Young MJ et al. Good practice guidance for the use of antibiotics in patients with diabetic foot ulcers. Diabetic Foot Journal2009;12:62-78.
20.
Young MJ, McCardle JE, Randall LE, Barclay JIImproved survival of diabetic foot ulcer patients 1995-2008: possible impact of aggressive cardiovascular risk management. Diabetes Care2008;31:2143-7.
21.
Prompers L. , Huijberts M., Apelqvist J. et al. Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study. Diabet Med2008;25:700-7.
22.
Leese GP, Brown K., Green V.Professional development for podiatrists in diabetes using a work based tool . Pract Diab Int2008;25:313-15.
23.
Donohue ME, Felton JA, Hook A. et al. Improving foot-care for people with diabetes mellitus: a randomised controlled trial of an integrated care approach. Diabet Med2002;17:581-7.
24.
National minimum skills framework for commissioning of foot care services for people with diabetes. FDUK, Diabetes UK, ABCD, PCDS, Society of Chiropodists and Podiatrists, 2006. www.footindiabetes.org/Guidelines/NatMinSkillFramewkFootNov06.pdf (accessed March 2011).
