Good discussion going on at the peripheral arterial disease (PAD) FB group at the moment. Do you treat the ingrown nail which your PAD patient presents with, or not? I gave the legal implications, based on a National Institute for Clinical Care Excellence (NICE) document – CG 147. This is the document the lawyers reach for if a case is being brought. NICE say that if your patient has already been diagnosed chronic PAD (defined as critical limb ischaemia) you should not contemplate treatment, but refer to a vascular multidisciplinary (MDT) team before treatment decisions are made. My impression is that for general footcare you are ok, but anything invasive – refer on to the MDT (who may refer back).
The document is not totally happy with the vascular tests carried out in the community or in primary care. These are usually doppler, pulse-palpation, and ABPIs – one or more of each. So simply doing these and assuming you’ll be ok is probably not a sensible option. The document is freely available on the internet – just Google NICE CG 147. Interesting reading!
Interesting read. So if a patient has PAD and presents with IGN but the PAD isn’t chronic or critical but has already been diagnosed prior to seeing us. We shouldn’t touch it and refer on. Is that correct or is it only for chronic cases?