News

Fast track for feet

Published 26 February 2013

Thousands of people a year endure a diabetes-related foot amputation because their foot ulcer is not treated quickly enough, according to a new report, backed by the University of Brighton.

The Diabetes UK report, called Fast Track For A Foot Attack: Reducing Amputations, warns that too many areas do not have the systems in place to ensure foot ulcers and foot infections in people with diabetes are treated within 24 hours. This is despite the fact that ulcers can deteriorate extremely quickly and a matter of hours can make the difference between keeping a foot and losing it.

It has highlighted the lack of these systems at a local level as one of the main reasons the number of foot amputations is increasing – there are already 6,000 diabetes-related amputations a year and this is projected rise to 7,000 by 2015. It is thought that up to 80 per cent of these amputations could be prevented.

The report, which Diabetes UK has produced with the Society for Chiropodists and Podiatrists and NHS Diabetes, makes recommendations that could dramatically reduce diabetes-related amputation rates and bring an end to the current situation where people with the condition are over 20 times more likely to have an amputation than the rest of the population.

The campaign is being backed by Alistair McInnes, senior lecturer in the University of Brighton's School of Health Professions and expert adviser to the Society of Chiropodists and Podiatrists.

He said: "The unacceptably high numbers of diabetes related amputations can be reduced by up to 80% by the implementation of an integrated foot care pathway which requires a dedicated Foot Protection Team and a hospital based Multidisciplinary Foot Care Team. There are challenging times ahead, but in the 30 years that I have been involved with diabetes foot care, we have never before had the extensive media coverage, level of support from Parliamentarians, nor the number of foot care experts to champion our cause. We have the evidence. We can save limbs, save lives and save money."

The recommendations include:

All hospitals should have a multi-disciplinary footcare team (MDT), which brings together different healthcare professionals to ensure good quality care for foot problems in people with diabetes. The National Institute for Health and Clinical Excellence recommends that these teams should be in place, but the most recent figures suggested 40 per cent of hospitals do not have them.
Every hospital should guarantee that people with urgent foot problems can be assessed by an MDT within 24 hours, as it is vital that foot problems are treated quickly.
Every area should have a system for identifying and regularly reviewing people at high risk of foot ulcers and infections, including annual foot checks and foot protection teams in the community.
People with diabetes who are at high risk of foot problems should know what to look out for and where to go in the event of a foot attack.

Barbara Young, Chief Executive of Diabetes UK, said: "It is unacceptable that every single week people with diabetes who have treatable foot problems are having feet or toes amputated because they are not being treated quickly enough.

"It is not as if this is a problem we don't know how to solve. If every hospital had a multi-disciplinary footcare team and ensured access to that team within 24 hours, then that would make a huge difference to the amputation rates. We also need to make sure people with diabetes are getting a thorough annual foot check and then those at high risk of amputation are given the help they need to prevent them. All too often, we hear stories about foot checks that are so fleeting that the person is not even asked to take their shoes off.

"This is not something that requires more money. In fact, putting these kind of systems in place can actually save money because the amputations that they prevent are so expensive. But we need leaders across the NHS, the NHS Commissioning Board and local clinical commissioning groups (CCGs), to insist that this happens and hold those areas that do not have these systems in place to account.

"We need action now."

Find out more about Diabetes UK's Putting Feet First campaign. The new report will also be available there.