Ignore the diabetic foot at your peril!
Understanding the importance of footcare for people living with diabetes is crucial. Early detection of foot problems and appropriate action can make the difference between loosing or keeping a foot!
A recent report from the charity Diabetes UK has shown that lower limb amputations related to diabetes in England has increased by 19.4%.
Dan Howarth, Head of Care at Diabetes UK said: “The shocking number of lower limb amputations related to diabetes grows year on year. An amputation, regardless of whether it’s defined as minor or major, is devastating and life-changing. A minor amputation can still involve losing a whole foot."
People living with diabetes should receive an annual examination to determine whether their foot sensation is intact and the blood supply to their feet is good, however this doesn’t always take place.
Given that diabetes affects around 25% of residents in care homes and 15% or more in mental health facilities, it is vital that people involved in their care understand the importance and have the skills and confidence in looking after the 'diabetic' foot; everyday care, spotting the signs of foot problems and knowing what to do dependent on level of risk.
Care/support workers are in a fantastic position to inspect and implement (or assist with) everyday footcare, as well as potentially spot foot problems which can then be promptly dealt with. If appropriately trained, they can also carry out a diabetic foot assessment for people unable to attend an annual diabetic review at their surgery.
NICE Guideline NG19 (Diabetic foot problems: prevention and management) states that diabetes foot assessments should ‘only be done by healthcare professionals with the relevant training and skills’.
[DUET diabetes provides a competency based diabetic foot screening workshop to meet this need.]
The risk of foot problems in people with diabetes is increased, largely because of either diabetic neuropathy (nerve damage or degeneration) or peripheral arterial disease (poor blood supply due to diseased large‑ and medium‑sized blood vessels in the legs), or both.
Peripheral arterial disease affects 1 in 3 people with diabetes over the age of 50, and can also increase the risk of heart attack and stroke. For more information, see the NICE guideline on lower limb peripheral arterial disease.
Within a document the CQC has issued 'guidance to staff inspecting the quality of care for residents with diabetes mellitus living in care homes', one of the elements of good diabetes care is stated as having "a risk-calculation and assessment tool for diabetes foot disease. Use of such a tool by suitably trained staff can reduce unnecessary amputations."
It is estimated that 10% of people with diabetes will have a diabetic foot ulcer at some point in their lives. Diabetic foot ulcers precede more than 80% of amputations in people with diabetes. A person living with diabetes is 20 times more likely to experience an amputation than someone without the condition.
The psychological impact of diabetic foot problems, in particular amputation, can be far reaching. People with diabetes with or without foot ulcers frequently suffer from major depressive disorder, and this can be made worse by limb complications. Depression itself can have negative consequences on a person’s diabetes. Hence, in caring for people with diabetic foot problems, the psychological ramifications must not be overlooked but managed accordingly.
Foot problems in people with diabetes have a significant financial impact on the NHS through primary care, community care, outpatient costs, increased bed occupancy and prolonged stays in hospital. A report published in 2012 by NHS Diabetes estimated that around £650 million (or £1 in every £150 the NHS spends) is spent on foot ulcers or amputations each year."
What is vitally important is that those who are undertaking the foot checks are adequately trained/competent in
performing the physical examination
knowing when to refer on
as well as communicating with the patient what "good footcare entails and the warning signs of potential problems"