Rachel Fieldhouse PATIENTS at moderate to high risk

of diabetic foot ulcers require med-

size , laminated and displayed in every treatment room ”.

The pathway recommends

The SINBAD wound classification system *

Category Definition Score

ical-grade footwear and should self-monitor foot skin temperatures daily for early signs of ulceration , updated guidelines suggest .

Doctors are also advised to diagnose foot infections based on the presence of at least two symptoms of local inflammation , including swelling / induration , erythema , tenderness / pain , warmth or purulent discharge . The new guidelines for diabetes-related foot disease — developed by Diabetes Feet Australia — include 98 recommendations for prevention , wound classification , infection management , wound healing , pressure off-

medical-grade footwear to reduce plantar pressure in those at moderate to high risk , as well as daily inspection for foot problems with temperature checks .

They can be ‘ displayed in every treatment room ’.

— Associate Professor Gary Kilov

If non-surgical treatment fails to reduce ongoing abundant callus or recurrent diabetic foot

Site

Ischaemia

Neuropathy

Bacterial infection

– Forefoot – Midfoot or hindfoot

– Pedal blood flow intact : at least one palpable pulse – Clinical evidence of reduced pedal flow

– Protective sensation intact – Protective sensation lost

– None – Present

Area – Ulcer < 1cm 2

0 – Ulcer ≥1cm 2 1

Depth

– Ulcer confined to skin and subcutaneous tissue – Ulcer reaching muscle , tendon or deeper

0 1

0

1

0 1

0 1

0 1

loading and peripheral artery disease . Associate Professor Gary Kilov , from the University of Melbourne ,

ulcers , the authors say “ various surgical interventions … should be considered ” for prevention .

* A total score ≥3 has been associated with delayed healing , but the guidelines stress individual components should also be reported

says they are “ timely updates ” that

The guideline summary , pub-

augment existing diabetes manage-

lished in The Medical Journal of

more effective communication

For wound management , the

fibrin dressings if available .

ment guidelines .

Australia , also recommends the SIN-

between health professionals , does

authors say initial selection of dress-

Dr Gary Deed , chair of the

“ The updates stress the impor-

BAD ( Site , Ischaemia , Neuropathy ,

not require any specialised equip-

ings should be based on cost , comfort

RACGP ’ s Specific Interests Diabetes

tance of prevention and screening of a

Bacterial infection And Depth ) wound

ment and has higher quality of evi-

and exudate control but advise against

group , said the updated section on

condition that can be debilitating and ,

classification system as the minimum

dence ,” it states .

use of dressings with surface antimi-

wound healing reflected emerging

in the worst case , life-threatening ,”

standard to document foot ulcers ( see

If an infection is diagnosed based

crobial agents to accelerate healing .

evidence .

says the Launceston GP , who was not involved in developing the guidelines .

He also says the new clinical pathway for preventing diabetic foot ulcers “ lends itself to being printed in A4

table ).

“[ This ] is a change to the previous guideline that recommended the University of Texas wound classification system as SINBAD has demonstrated

on at least two signs of local inflammation , the Infectious Diseases Society of America / International Working Group on the Diabetic Foot system can be used to classify severity .

For non-healing foot ulcers , clinicians can consider sucrose octasulfate-impregnated dressings , placental-derived products or autologous combined leucocyte , platelet and

The guidelines were funded by the National Diabetes Services Scheme , Diabetes Feet Australia and the Australian Diabetes Society .