Foot-care is vital to diabetic health
Care & Medication There are a staggering 135 diabetes-related amputations every week in England. What is going wrong and what can be done to improve the outlook?
The amputations involved are toes, feet and below-the-knee operations. The impact on individuals, families, and society is huge, says Dr Paul Chadwick, Clinical Director of the College of Podiatry.
“Diabetes-related foot complications cost the NHS £1 billion a year. That doesn’t include on-costs such as rehabilitation or adaptation of houses and cars. The impact on quality of life for the individual is massive: they may suffer depression, or feel they have lost their place in society if they’re unable to work; they need to attend regular appointments, have special shoes and prosthetic limbs fitted.”
Four out of five amputations could be prevented, given proper attention to foot care, correct advice, and rapid access to preventative services.
“Eighty per cent of amputations are preceded by foot ulceration, which is also a first marker for serious problems such as strokes and heart attacks.”
Dr Chadwick explains that “every person with diabetes should receive an annual 10-point check-up which includes foot health; if they are at risk of a foot ulcer they should be referred into managed treatment and specialised services. The problem is access: the model in the UK is highly developed in terms of screening and identifying, but there is not enough investment in ensuring rapid access to the specialised and foot protection services.”
The role of podiatry
More investment in foot-care services would save patients trauma, and the NHS £250 million, he says. “We’re currently training about 400 new podiatrists a year and we need 7,000. Bursaries for the three-year podiatry degree have, like nursing bursaries, been cut in England, where the majority of the podiatry courses are run.”
A trained podiatrist will be aware of the link between diabetic foot ulceration and heart attack or stroke: “Ulceration increases the mortality rate from vascular causes by 50 per cent – that’s more than for most cancers. It can be treated but the patient’s treatment needs to be managed. As non-medical prescribers, podiatrists are now able to prescribe antibiotics and some other life- and limb-saving medication.
What to look out for
If you have diabetes , he advises that you check your feet every day and see a podiatrist or GP urgently if you notice heat, new discoloration, new swelling, a break in the skin or any other changes. This service is available on the NHS for increased-risk patients, and private podiatry is also available.
“If your foot develops a wound, seek help urgently. The faster you are seen, the better the healing outcome.”
There are multi-disciplinary teams across most of the country, if you are in contact about a woudn, you should be seen within one day. The faster you are seen, the better the healing outcome.”
People with diabetes should ensure they receive their annual check-up, says Dr Chadwick. “If you are identified as being at risk of ulceration, you should be referred to specialist services. Ask for podiatry and foot protection services. Ask your GP or commissioner, and insist if you have to.”
For those with Type 2 diabetes, weight may be a significant factor, so you can also improve your outlook through diet and exercise, he explains. “Neuropathy, or nerve damage, can alter the foot shape and reduce sensation. Increased weight increases pressure on the foot, which can cause ulceration – a patient with neuropathy may carry on walking on an injured foot because they can’t feel the warning sign of pain. Therefore it is essential that your feet are checked every day.”
Obesity is unleashing a worldwide epidemic of diabetes: “It’s on the rise in developing countries as they adopt the western diet and less active lifestyles. They will have significant problems with amputations. Every 20 seconds, someone in the world loses a limb to diabetes.”
"Awareness at the individual, clinical and political levels is key."
“Here in Britain, Diabetes UK has a powerful campaign called Putting Feet First, and I chair Foot in Diabetes UK, which is for clinicians. We are pushing any door that opens to raise awareness.”