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Shared Care Pathway for Management of 
Foot Ulceration for Patients under the 
Care of Podiatry and Community Nursing 
Services 
 
Unique Identifier: 
ALTC/SOP/017 
Version Number: 

Type of Update / Status:  Ratified - New Document 
Divisional and 
Podiatry and Community Nursing, Adults and Long Term 
Department: 
Conditions 
Author / Originator and 
Yasmin Mulhall – Clinical Care Coordinator – Central 
Job Title: 
Neighbourhood 
Joanne Fear – Team Leader – Central Neighbourhood 
Maria Remo Loida – Advanced Podiatrist - Blackpool 
Emma Phillips – Advanced Podiatrist – Blackpool 
Debbie Wilford – Advanced Podiatrist - Wyre 
Susan Baldwin – Senior Community Nurse – South Shore 
Neighbourhood 
Chloe Cross – Community Nurse – North Shore 
Neighbourhood 
Emma Clarke – District Nurse – Central West Neighbourhood 
Replaces: 
New document 
Description of 
N/a 
amendments: 
Approved by: 
Adults and Long Term Conditions Divisional Policy Group 
Approved Date: 
06/11/2020 
Issue Date: 
06/11/2020 
Review Date from Date 
1 Year 
2 Years 
3 Years 
4 Years 
5 Years 
of Approval: 
☐ 
☐ 
☒ 
☐ 
☐ 
 
 
06/11/2023 
 
 
 
Version Control Sheet 
This must be completed and form part of the document appendices each time the 
document is updated and approved 
Date 
dd/mm/yy  Version 
Author 
Reason for changes 
06/11/20 

Yasmin Mulhall – Clinical Care 
New document 
Coordinator – Central Neighbourhood 
Joanne Fear – Team Leader – Central 

Version Control Sheet Neighbourhood 
Maria Remo Loida – Advanced 
Podiatrist – Blackpool 
Emma Phillips – Advanced Podiatrist – 
Blackpool 
Debbie Wilford – Advanced Podiatrist – 
Wyre 
Susan Baldwin – Senior Community 
Nurse – South Shore Neighbourhood 
Chloe Cross – Community Nurse – 
North Shore Neighbourhood 
Emma Clarke – District Nurse – Central 
West Neighbourhood 
 Consultation / Acknowledgements with Stakeholders 
Name 
Designation 
Date Response 
Received 
Lorraine Wilkinson 
Head of Locality 
6/8/2020 
Jan Bamber 
Complex Care Coordinator and NMP Lead 
5/8/2020 
James Earle 
Team Leader 
5/8/2020 
Kay Dalton 
Team Leader 
6/8/2020 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 2 of 15 

link to page 1 link to page 2 link to page 4 link to page 4 link to page 4 link to page 4 link to page 4 link to page 4 link to page 5 link to page 6 link to page 8 link to page 9 link to page 9 link to page 10 link to page 12 link to page 14 CONTENTS 
Version Control Sheet .......................................................................................................... 1 
Consultation / Acknowledgements with Stakeholders .......................................................... 2 

Introduction / Purpose ................................................................................................. 4 
1.1  Purpose ................................................................................................................... 4 
1.2  Introduction ............................................................................................................. 4 

General Principles / Target Audience .......................................................................... 4 

Responsibilities (Ownership and Accountability) ......................................................... 4 
3.1  Al  Health Care Professionals involved in wound management .............................. 4 
3.2  Community Nurses / Treatment Room Nurses ........................................................ 5 
3.3  Podiatrists ............................................................................................................... 6 

The Care Pathway ....................................................................................................... 8 

Training ....................................................................................................................... 9 
5.1  Monitoring (Including Standards) ............................................................................ 9 

References and Associated Documents ................................................................... 10 

Definitions and Abbreviations .................................................................................... 12 
Appendix 1: Equality Impact Assessment Form ................................................................. 14 
 
 
 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 3 of 15 

1  Introduction / Purpose 
 1.1  Purpose 
 
The purpose of this standard operating procedure is to create a pathway for shared care 
between podiatry services and community nursing for patients with foot ulceration.  This 
wil  help patients to receive appropriate care in a timely manner, and ensure that foot 
wounds are managed effectively and there are no delays in treatment. 
 1.2  Introduction 
 
It was identified that there was a need to standardise practice across disciplines of Nursing 
and Podiatry, to improve patient outcomes. 
 
Nurses have specialist knowledge in the management of patients with ulcers and this 
combined with the specialist knowledge of sharp debridement skil s and off-loading 
techniques by Podiatrists means a natural combined approach would greatly benefit 
patient care resulting in improved quality of life and improved outcomes for patients. 
 
Current government legislation promotes multidisciplinary integrated working as it is known 
that this will promote improved patient outcomes  (1). 
 
A review group was formulated consisting of Podiatrists and Community Nurses from the 
Blackpool Fylde and Wyre localities.  Current practice was identified including variances in 
practice between localities and it was identified that there was no current pathway in place. 
The pathway is designed to streamline care for patients with foot ulceration or pressure 
ulceration (foot or heel), peripheral vascular disease and high risk diabetic patients. 
 
2  General Principles / Target Audience 
 
The pathway wil  be used by all community nursing teams and podiatrists involved in the 
care of patients with foot ulcers. 
 
3  Responsibilities (Ownership and Accountability) 
3.1  Al  Health Care Professionals involved in wound management 
 
In order to implement this pathway in clinical practice all Health Care Professionals 
involved in wound management wil : 
 
• 
Identify learning needs in relation to wound management as part of their 
development requirements. 
• 
Access training as outlined in section 5.0 in order to maintain their competence and 
safe practice.    
• 
Liaise with other members of the multi-disciplinary team in order to plan and co-
ordinate appropriate wound management for patients. 
• 
Undertake a holistic assessment of the patient to identify potential factors that may 
affect wound healing and wherever possible take action to maximise potential for 
healing. 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 4 of 15 

 
Accurate documentation must be completed at initial presentation and each visit thereafter 
should deterioration occur and must include the following:  
 
• 
Location of wound (on body / foot map) 
• 
Date of onset  
(to be documented at initial visit and on the front of each consecutive wound chart) 
• 
Length  
• 
Width 
• 
Depth 
• 
Undermining area 
• 
Wound bed descriptors / tissue type  
(e.g. Granulation, slough, necrosis, tendon, bone etc.) 
• 
Exudate (type and amount) 
• 
Presence or absence of clinical signs of infection  
(including details of wound swab culture and sensitivity) 
• 
Pain Score 
• 
Wound photography as per Medical Photography Policy (CORP/PROC/002) (2).  
Clinicians who have been issued with a Trust-encrypted mobile phone that has been 
enabled for use with the ‘WABA MIM’ must ensure that the appropriate level of 
consent has been obtained prior to the taking of photographs and that this has been 
documented.  The deleting of images once the images have been uploaded from the 
Trust device to the WABA MIM / EMIS wil  be automatic 
• 
Plan of care / treatment aims 
 
Al  health care professionals have a duty to ensure appropriate actions are taken following 
reassessment.  Where any concern is identified or if a wound is failing to heal the 
healthcare professional should seek advice from a senior within the team and if 
appropriate escalate a referral to the Tissue Viability Service. 
 3.2  Community Nurses / Treatment Room Nurses 
 
Community Nurses and Treatment Room Nurses wil : 
 
• 
Undertake holistic assessment of the patient with foot ulceration to include 
assessment of vascular status using ankle-brachial pressure index (ABPI) or Toe-
brachial pressure index (TBPI), unless already completed by vascular or podiatry) 
and 
• 
Waterlow risk assessment to be completed and updated as per trust policy (3) 
• 
Ensure Care Plan is implemented 
• 
Patient / carer information (4) wil  be provided around Pressure Ulcer Prevention and 
Management Guidelines 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
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• 
Skin assessment to be completed – to include all potentially vulnerable areas 
• 
Support surfaces to be assessed (and provision of equipment arranged if required) 
• 
Advise Patient Keep moving – if patient is nursed in bed a repositioning regime to be 
established personalised to the patient and pressure relieving advice to be given 
• 
Incontinence  is assessed and appropriate management plan is implemented 
• 
Nutrition and Hydration assessment (MUST) completed and appropriate action plan 
implemented and referral on to dietitian is initiated if required. 
• 
A wound assessment tool is completed and an appropriate wound management care 
plan is implemented to include: 
(a)  Skin care including care of the foot and emollients prescribed 
(b)  Dressing choice and rationale for treatment 
(c)  Frequency of dressing change 
(d)  Evaluation of wound management and wound progression. 
• 
Refer all patients with foot ulceration to podiatry for further assessment of the foot as 
per the following Shared Care Pathway for Foot Ulceration (Section 4.0).  
• 
Complete an untoward incident report (5) for all patients with pressure ulceration to 
the heel or foot and follow relevant guidelines to ensure that the patient receives 
appropriate assessment and management. 
• 
Documentation of Consultant involvement where applicable (e.g. Vascular, Diabetic 
MDT, Renal etc.) 
 3.3  Podiatrists 
 
Podiatrists will:  
 
• 
Complete holistic assessment of the patient with foot ulceration to include 
assessment of vascular status and neurological assessment where appropriate 
unless already completed by another service (e.g. Vascular Service, Community 
nursing) 
• 
Refer the patient to appropriate Community Nursing Team for ongoing care as per 
the Shared Care Pathway For the management of Foot Ulceration.  Shared care may 
also be appropriate for some patients following nail surgery. 
• 
Where minor cuts are caused in the process of trimming nails, the podiatrist should 
assess appropriateness of self-care by the patient (where appropriate).  If the patient 
is unable to self-manage, then the podiatrist should maintain their duty of care to the 
patient and continue treatment until healed. 
• 
Assess the patient’s suitability for sharp debridement, off-loading, bio-mechanics and 
discuss frequency of podiatry input required with appropriate nursing staff who wil  
devise and implement the plan of care. 
• 
Ensure that patients who have plantar surface ulceration have adequate off-loading 
prior to referral to Ambulatory Services in order to prevent potential for deterioration. 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 6 of 15 

• 
Complete an untoward incident report (5) for all patients with pressure ulceration to 
the heel or foot (unless already completed by another service) and follow relevant 
guidelines to ensure that the patient receives appropriate assessment and 
management. 
 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 7 of 15 

4  The Care Pathway  
 
 
New Referrals are received by appropriate services 
 
Initial assessment undertaken by the service receiving the referral 
 
Initial presentation of foot ulcer (below the malleolus) consider joint working 
pathway below 
 
 
 

Assessment of vascular status to include ABPI / TBPI 
 
Non Urgent: 
 
Holistic assessment and prescribe treatment plan, 
 
consider: 
 
All foot ulcers: 
 
Follow clinical wound management guidelines, reassess 
 
Urgent   
at every visit for evidence of infection, complete wound 
Absent foot pulses 
 
assessment documentation every week 
Plan of care to include: debridement (if applicable and 
 
Ischaemic rest pain  
dependent upon normal ABPI), wound management, off-
 
Loss of function 
loading or footwear, skin care, management of factors 
 
Hot/swollen foot 
which may delay healing 
 
Patient unwell:  
Special Risks: 
 
pyrexia or flu like symptoms 
Diabetic? – urgent referral to diabetic MDT & 
 
Take photographic evidence 
Advanced podiatrist for advice 
 
Discuss with Advanced 
Pressure Ulcer? –UIR to be completed at initial 
 
Podiatrist for advice 
presentation by Podiatrist / Nurse Photograph and 
 
Liaise with on call 
complete wound assessment documentation 
 
vascular services 
Increased risk of infection?  Rheumatoid / Diabetes / 
 
Immunosuppressants / Peripheral Vascular Disease 
 
 

A new or deteriorating ulcer below the malleolus 
 
Urgent 
consider joint visit nursing/podiatry or consultation to 
  Nurse / Podiatrist seeing the 
provide a shared plan of care 
 
patient takes immediate 
 
  appropriate action e.g. admit 
 
to hospital (999) or contact GP 
 
Coordinator for shared care should be community 
/ GP on-call for advice / 
 
nurse unless explicitly agreed otherwise.  
contact Vascular Nurse 
 
Specialist for admission / 
 
advice 
Negotiated plan of care to focus on the needs/benefits 
 
to the patient. 
 
 
 
Community Nurse undertakes ongoing wound assessment and 
 
management including responsibility for prescribing. 
 
 Podiatrist provides specialist sharp debridement off-loading strategies 
 
as required – frequency negotiated between Nurse/ Podiatrist and this 
 
must be documented in plan of care 
 
The treatment plan should be followed until the prescribing 
 
professional has been consulted and prescription changed. 
 
Changes to foot ulceration: 
 
Urgent / Acute 
follow pathway as above  
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 8 of 15 

5  Training 
 
Al  staff involved in wound management on the feet should attend the following educational 
training where required.  Sessions are advertised through the clinical improvement team 
patient safety training booklet and OLM via One HR. 
 
• 
Tissue Viability as part of trust induction 
• 
Doppler and Lower Limb Assessment and procedure for measuring ABPI and TBPI 
• 
Pressure Ulcer Prevention and Management Workbook 
 
Advanced podiatrists and community nursing link nurses also offer in house training 
sessions on request and this can be booked by contacting them direct.  
 5.1  Monitoring (Including Standards) 
 
Standard 
Time frame / 
format 
How 
Whom 
Patients with a new wound 
Annual 
Records audit through 
Team leader / 
identified below the malleolus 
1-1 supervision and 
Clinical Lead 
to have vascular assessment 
peer review 
(and ABPI) undertaken within 2 
weeks of first assessment and 
Documentation on EMIS 
repeated as per Doppler policy 
Patients identified as showing  Annual 
Records audit through 
Team leader / 
signs of deterioration in foot 
1-1 supervision 
Clinical Lead 
ulceration a joint visit / 
consultation by podiatrist and 
Documentation on EMIS  
nurse has been instigated 
For patients with foot 
Annual 
Records audit through 
Team leader / 
ulceration photographs are 
1-1 supervision 
Clinical Lead 
available to show initial 
presentation 
Documentation on EMIS  
 
 
 
 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 9 of 15 

6  References and Associated Documents 
 
1. NHS. NHS Long Term Plan. [Online] 21 08 2019. [Cited: 20 07 2020.] 
https://www.longtermplan.nhs.uk/. 
2. BTHFT - Procedure. Photography and Video Recordings of Patients: Confidentiality 
and Consent, Storage and Copyright. [Online] 08 03 2017. [Cited: 29 10 2020.] 
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-002.docx. 
CORP/PROC/002. 
3. —. Tissue Viability / Pressure Ulcer Risk Assessment, Management / Prevention / 
Treatment and Reporting. [Online] 18 04 2019. [Cited: 06 02 2020.] 
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-642.docx. 
CORP/PROC/642. 
4. BTHFT - Leaflets. How to help keep yourself safe. [Online] 04 05 2019. [Cited: 22 01 
2020.] http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Information%20Leaflets/PL1005.pdf. 
5. BTHFT - Policy. Management of Incidents, Incorporating Serious Incidents. [Online] 18 
10 2019. [Cited: 03 01 2020.] 
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-605.docx. 
CORP/POL/605. 
6. British Orthopaedic Association, British Orthopaedic Foot and Ankle Society, 
Vascular Society, Diabetes UK, Association of British Clinical Diabetologists, Foot 
in Diabetes UK; British Association of Prosthetists and Orthotists. Operational 
Delivery of the Multi-Disciplinary Care Pathway for Diabetic Foot Problems. [Online] 04 
2016. [Cited: 06 11 2020.] https://www.diabetes.org.uk/professionals/position-statements-
reports/specialist-care-for-children-and-adults-and-complications/operational-delivery-of-
the-multi-disciplinary-care-pathway-for-diabetic-foot-problems. 
7. Department of Health and Social Care. Our health, our care, our say: a new direction 
for community services. [Online] Published 30 January 2006. [Cited: 05 05 2020.] 
https://www.gov.uk/government/publications/our-health-our-care-our-say-a-new-direction-
for-community-services. 
8. —. Policy Paper - 2010 to 2015 government policy: health and social care integration. 
[Online] 08 05 2015. [Cited: 06 11 2020.] 
https://www.gov.uk/government/publications/2010-to-2015-government-policy-health-and-
social-care-integration/2010-to-2015-government-policy-health-and-social-care-integration. 
9. Crown. Health and Social Care Act 2012. [Online] 2012. [Cited: 06 03 2020.] 
http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted. 
10. International Diabetes Federation. IDF Clinical Practice Recommendations on the 
Diabetic Foot. [Online] 2017. [Cited: 06 11 2020.] https://www.idf.org/about-diabetes/54-
our-activities/222-idf-clinical-practice-recommendations-on-the-diabetic-foot.html. 
11. National Wound Care Strategy Programme. Lower Limb Recommendations. 
[Online] 14 10 2020. [Cited: 06 11 2020.] https://www.ahsnnetwork.com/about-academic-
health-science-networks/national-programmes-priorities/national-wound-care-strategy-
programme/clinical-workstreams/lower-limb-clinical-workstream. 
12. North West Coast Strategic Clinical Network. Diabetes Footcare Blueprint. [Online] 
10 2018. [Cited: 06 11 2020.] https://www.england.nhs.uk/north-west/north-west-coast-
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 10 of 15 

strategic-clinical-networks/our-networks/diabetes/protocols-and-standards/diabetes-
footcare-blueprint-report-and-key-documents/. 
13. NICE. Diabetic foot problems: prevention and management. [Online] Last updated: 11 
October 2019. [Cited: 06 11 2020.] https://www.nice.org.uk/guidance/ng19. NICE guideline 
[NG19]. 
14. The Col ege of Podiatry. Good Practice in Prescribing and Medicinie Management for 
Podiatrists. 3rd Edition. [Online] 09 2018. [Cited: 06 11 2020.] https://cop.org.uk/the-
college/medicines/policy-and-guidance. 
15. BTHFT - Procedure. Conservative Sharp Debridement in Advanced Wound 
Management. [Online] 04 05 2018. [Cited: 06 11 2020.] 
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-711.docx. 
CORP/PROC/711. 
16. —. Leg Ulcer and Doppler Assessment Procedures. [Online] 29 06 2017. [Cited: 06 11 
2020.] http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-635.docx. 
CORP/PROC/635. 
17. BTHFT - Policy. Medicines Policy. [Online] 20 12 2018. [Cited: 17 02 2020.] 
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-300.docx. 
CORP/POL/300. 
18. BTHFT - Procedure. Consent to Examination or Treatment. [Online] 06 06 2018. 
[Cited: 02 11 2020.] http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-
PROC-102.docx. CORP/PROC/102. 
19. BTHFT - Policy. Infection Prevention (Covid-19 updated). [Online] 10 05 2019. [Cited: 
05 10 2020.] http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-POL-
116.docx. CORP/POL/116. 
20. BTHFT - Procedure. Health Record – Generic Clinical Record Keeping Standards 
Procedure. [Online] 21 11 2019. [Cited: 22 01 2020.] 
http://fcsp.xfyldecoast.nhs.uk/trustdocuments/Documents/CORP-PROC-567.docx. 
CORP/PROC/567. 
Central Lancs diabetes steering group (2009) Central Lancashire diabetes guidelines: 
Central Lancashire diabetes steering group. 
DH 2012 Health and Social Care Bil . 
Management of Black heels- A Multidisciplinary approach (NHSSB) The northern health 
and social services board (2005) 
NICE.  (2008).  Quality and Productivity: Supplementary Prescribing In Podiatry.  
www.evidence.nhs.uk/qualityandproductivity 
North West Podiatry Services PVD Clinical Effectiveness Group. (2020). Guidelines for the 
Assessment of Peripheral Vascular Disease.  North West Podiatry Services PVD Clinical 
Effectiveness Group. 
Popadiuk S. (2010),  NMP in a MDT Diabetic Foot Clinic – Poster Presentation.  Presented 
at International Conference on the Diabetic Foot, Uppsalla Sweden 2010. 
The society of Chiropodists and Podiatrists (2010) A guide to the benefits of podiatry to 
patient care.  
 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 11 of 15 

7  Definitions and Abbreviations 
 
ABPI  
Ankle Brachial Pressure Index -  A method of assessing the arterial blood 
supply to the lower limbs 
Abscess 
A pus-fil ed cavity resulting from inflammation and usual y caused by 
bacterial infection 
Acute 
A disease/disorder that is brief with sudden onset 
Aetiology 
The cause of – disease/disorder 
Arterial 
Involving or contained in the arteries 
Aseptic 
Free of disease-causing microorganisms 
Bacteraemia  The presence of bacteria in the blood 
Cellulitis 
Inflammation of any of the tissues of the body, characterized by fever, 
pain, swelling, and redness of the affected area 
Chronic 
An il ness or medical condition that lasts over a long period and 
sometimes causes a long-term change in the body 
Colonised 
The presence of bacteria on the body surface without causing disease in 
the person 
Conservative  Relieve symptoms or preserve health with minimum simple intervention 
Culture and sensitivity 
 
A test to define  the type of bacteria and to determine which antibiotics can 
successfully fight the infection 
Debridement  Removal of dead, devitalized, contaminated tissue or foreign matter from a 
wound 
Doppler 
A test that measures the blood pressures in the legs to make sure there is 
normal blood flow 
Dressing 
A therapeutic or protective material applied to a wound 
Emollient 
An agent that hydrates, softens or soothes the skin 
Erythema 
Redness of the skin caused by dilatation and congestion of the capil aries, 
often a sign of inflammation or infection 
Excoriated 
Wearing or abrasion of the skin 
Foot ulcer   
Wound present below the malleolus 
Granulation 
Small, fleshy, beadlike nodules, consisting of outgrowths of new 
capil aries, on the surface of a wound that is healing 
Haemorrhage  Bleeding from ruptured blood vessels 
Holistic 
Relating to the consideration of the complete person 
Infection 
Invasion and multiplication of microorganisms in body tissue 
Inflammation  Swelling, redness, heat, and pain produced in an area of the body as a 
reaction to injury or infection 
Macerated 
White softened tissue caused by prolonged exposure to moisture 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
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Malleolus 
The ankle bone 
Malnutrition 
A lack of healthy foods in the diet, or an excessive intake of unhealthy 
foods, leading to physical harm 
Malodour 
A distinctive odour that is offensively unpleasant 
Microbiology  The scientific study of microscopic organisms and their effects 
Microcirculation 
The flow of blood or lymph through the smallest vessels of the body 
Necrotic 
The death of cells in tissue caused by disease or injury. 
Oedema 
A build-up of excess serous fluid between tissue cells 
Pathogenic organism 
Bacteria that produce il ness 
Pressure Ulcer  A pressure ulcer is localised injury to the skin and/or underlying tissue 
usually over a bony prominence, as a result of pressure, or pressure in 
combination with shear and/or friction 
Purulent 
Relating to containing or consisting of pus 
Pus 
The yellowish or greenish fluid that forms at sites of infection, consisting of 
dead white blood cel s, dead tissue, bacteria, and blood serum 
Pyrexia 
High temperature or fever 
Sanguinous 
Relating to blood; bloody 
Scab 
A hard crust of dried blood, serum, or pus that forms over a wound during 
healing 
Sepsis 
The condition or syndrome caused by the presence of microorganisms or 
their toxins in the tissue or the bloodstream 
Septicaemia  Toxic microorganisms in the bloodstream 
Serosanguinous 
Consisting of clear serum and blood 
Slough  
Dead tissue, usually cream or yellow in colour present on a wound bed 
Strike-through  Leakage of wound exudate onto the outside of a dressing/bandage 
TBPI 
Toe Brachial Pressure Index -  A method of assessing the arterial blood 
supply to the lower limbs using the toes 
UIR 
Untoward Incident Report 
Ulcer 
Wound on the skin that does not heal and results in the destruction of 
tissue 
Undermining  Areas of tissue loss underneath intact skin or a hollow between the skin 
surface and a wound bed 
Vascular insufficiency 
 
Inadequate peripheral blood flow, caused by disease, obstruction or 
blockage 
Venous 
Relating to or involving the veins 
Venous return  Blood in the veins, which is returning to the heart 
Wound 
Injury to the skin, cause by trauma or disease 
 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
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Appendix 1: Equality Impact Assessment Form 
Department 
Clinical Quality & 
Service or Policy 
ALTC/SOP/017 
Date Completed: 
January 2018 
Ef ectiveness 
GROUPS TO BE CONSIDERED 
Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and families, young 
people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men, parents, carers, staff, wider 
community, offenders. 
EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED 
Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and social economic / 
deprivation. QUESTION 
RESPONSE 
IMPACT 
Issue 
Action 
Positive 
Negative 
What is the service, leaflet or policy 
To guide the use of conservative sharp 
 
 
 
development? 
debridement for wound management by 
What are its aims, who are the target 
the Tissue Viability Team 
audience? 
Does the service, leaflet or policy/ 
No 
 
 
 
development impact on community safety 
• 
Crime 
• 
Community cohesion 
Is there any evidence that groups who 
No 
 
 
 
should benefit do not? i.e. equal 
opportunity monitoring of service users 
and/or staff. If none/insufficient local or 
national data available consider what 
information you need. 
Does the service, leaflet or development/ 
No 
 
 
 
policy have a negative impact on any 
geographical or sub group of the 
population? 
How does the service, leaflet or policy/ 
No 
 
 
 
development promote equality and 
diversity? 
Does the service, leaflet or policy/ 
No 
 
 
 
development explicitly include a 
commitment to equality and diversity and 
meeting needs? How does it demonstrate 
its impact? 
Does the Organisation or service 
No 
 
 
 
workforce reflect the local population? Do 
we employ people from disadvantaged 
groups 
Wil  the service, leaflet or policy/ 
No 
 
 
 
development 
i.  Improve economic social conditions 
in 
deprived areas 
ii.  Use brown field sites 
iii.  Improve public spaces including 
creation of green spaces? 
Does the service, leaflet or policy/ 
No 
 
 
 
development promote equity of lifelong 
learning? 
Does the service, leaflet or policy/ 
No 
 
 
 
development encourage healthy lifestyles 
and reduce risks to health? 
Does the service, leaflet or policy/ 
No 
 
 
 
development impact on transport? 
What are the implications of this? 
Does the service, leaflet or 
No 
 
 
 
policy/development impact on housing, 
housing needs, homelessness, or a 
person’s ability to remain at home? 
Are there any groups for whom this 
No 
 
 
 
policy/ service/leaflet would have an 
impact? Is it an adverse/negative impact? 
Does it or could it (or is the perception 
that it could exclude disadvantaged or 
marginalised groups? 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 14 of 15 

Appendix 1: Equality Impact Assessment Form 
Does the policy/development promote 
No 
 
 
 
access to services and facilities for any 
group in particular? 
Does the service, leaflet or 
No 
 
 
 
policy/development impact on the 
environment 
•  During development 
•  At implementation? 
ACTION: 
Please identify if you are now required to carry out a Full Equality 
Yes 
No 
(Please delete as 
Analysis 
appropriate) 
Name of Author: 
 
Date Signed: 
 
Signature of Author: 
 
 
Name of Lead Person: 
 
Date Signed: 
 
Signature of Lead Person: 
 
 
Name of Manager: 
 
Date Signed: 
 
Signature of Manager 
 
 
Blackpool Teaching Hospitals NHS Foundation Trust 
ID No. ALTC/SOP/017 
Title: Shared Care Pathway for Management of Foot 
Revision No: 1 
Next Review Date: 0611/2023 
Ulceration for Patients under the Care of Podiatry 
and Community Nursing Services 
UNCONTROLLED COPY WHEN PRINTED 
Current Version held on the Intranet 
Page 15 of 15 

Document Outline