When undertaking a Telehealth consult with a person with diabetes and At-Risk Feet but no current foot ulcer, foot checks remain an important component of their healthcare. You can support preventative self-care behaviours and rapid intervention if diabetes-related foot disease is identified. This is especially important while patients are self-isolating and regular care processes are interrupted. Refer to the Integrated Diabetes Foot Care Pathway for risk status and management pathways.
If a person has a current foot ulcer, they should be under interdisciplinary HRFS (iHRFS) care as per the DFA COVID-19 document. https://www.diabeticfootaustralia.org/dfd-and-covid19/
The following questions may assist in introducing a foot check to your telehealth consult:
- Video-enabled – ask your patient to take off their shoes and socks and check the feet for changes, such as:
- Ulcers, wounds, lesions or blisters which may require immediate treatment. These may require basic dressing advice (saline flush and application of a sterile dry dressing) and ongoing monitoring OR a face-to-face consult either in rooms or your local iHRFS.
- Hot spots or areas of skin discoloration – consider further questioning to establish the presence of infection or sepsis – follow local guidelines if present – ie face-to-face vs referral to local ED for management.
- Voice-only – ask them to:
- take off their shoes and socks and check the feet for changes (they may need help from a carer or use of a mirror)
- Describe their feet from top to bottom including between their toes
- Look for any skin changes, including discoloration, temperature &/or cuts, blister, rubs or ulcers. If there are areas of concern and they have access to a digital camera (including smart phone), request that they send the photos for review OTHERWISE a face-to-face consult may be indicated.
A person risk status (their risk of developing DFD) will guide how often their feet should be checked by a healthcare professional:
Remember to reinforce preventative self-care behaviours
- Kolltveit, Beate‐Christin & Gjengedal, Eva & Graue, Marit & Iversen, Marjolein & Thorne, Sally & Kirkevold, Marit. (2016). Telemedicine in diabetes foot care delivery: Health care professionals’ experience. BMC Health Services Research. 16. 10.1186/s12913-016-1377-7.
- Lazzarini PA, Clark D, Mann RD, Perry VL, Thomas CJ, Kuys SS. Does the use of store-and-forward telehealth systems improve outcomes for clinicians managing diabetic foot ulcers? A pilot study. J Foot Ankle Res. 2011;4(Suppl 1):P31. Published 2011 May 20. doi:10.1186/1757-1146-4-S1-P31