Prevention of Amputation Caroline Leith Team Leader

1-4% of people with diabetes will develop an ulcer per year (Leese at al, 2011; TRIEPodD-UK, 2012). Approximately 58% of DFU patients will become clinically infected. (Eurodiale study group 3) The number of diabetes-related amputations in England has now reached an all-time high of 20 a day (Diabetes UK 2016) 1-4% of people with diabetes will develop an ulcer per year Leese et al According to a study published by the Eurodiale study group 3, approximately 58% of DFU patients will become clinically infected. Amputation rate is on the rise: Public Health England data suggests there are about 7,370 amputations a year, compared to the previous figure of 7,042, according to Diabetes UK. So to begin these are some of the latest statistics which do not give a very optimistic outlook for our patients with Diabetes.

Individuals with diabetic foot ulcers have a 50% chance of mortality in 5 years (Young 2012) Early diagnosis and early intervention by an MDT approach can achieve good outcomes (Edmonds2009) Studies have shown that individuals with diabetic foot ulcers have a 50% chance of mortality in 5 years ( Young 2012) However research has shown that with early diagnosis and intervention within a multidisciplinary team can achieve good outcomes but it’s a huge challenge for us as health professionals. I am now going to present 2 case studies which demonstrate successful MDT working

Case Study One Red Hot swollen Foot

Case Study One

Learning Points Any red hot swollen foot to consider Charcot until proven otherwise. Urgent referral to MDT. Early diagnosis helps prevent deformity. A diagnosis of Charcot is a life changing event for the patient

Case Study 2 Complex Foot Ulceration

Early referral to podiatry and the MDT is essential. Good MDT working prevents major amputation. Patients with a history of a foot ulcer have a 50% risk of re-ulceration.

Diabetic Foot Community clinics Clinics MDT Foot clinics Diabetic Foot Community clinics Clinics All of our 25 clinics across Hertfordshire see patients with Diabetes at both increased and high risk Many of these patients will have an ulcer. In the year 2013/2014 there were approximately 2500 patients with Diabetic foot ulcers seen by Podiatry. Our guidelines suggest that if the ulcer is not improving in 6 weeks or is deteriorating the patient can be referred into the Diabetic foot care clinics. These clinics are led by Podiatrists who work within the MDT with a specialist interest in Diabetes. These patients may alternate/rotate have their care jointly between the MDT and DFCC. 5 MDT clinics WGH- 6 appt slots HHGH - 10 appt slots Lister - 16 appt slots QE2 - 10 appt slots HCH - 2 appt slots MDT capacity is currently limited West Hertfordshire 16 appointments per week East Hertfordshire 28 appointments per week When people with a foot attack get rapid access for treatment by a specialist multi-disciplinary team this has been shown to promote faster healing and fewer amputations, saving money and lives.

The Multidisciplinary Diabetes Team Diabetologist Paediatric Consultant Practice Nurse Diabetes Specialist Nurse District Nurse The Patient G.P. Dieticians Tissue Viability Nurses Orthotist We are all part of that multidisciplinary team and each have a role for the care of these complex patients Podiatrists Orthopaedic Surgeon Pharmacist Radiologist Microbiologist Vascular Surgeon

Increased Diabetic Feet Your feet have been assessed as being at increased risk of developing diabetic foot complications. Podiatry Head Office: 01582 711544 (Mon – Fri 08.30 – 16.30) Diabetic Foot Emergencies: New pain or throbbing Foot hotter than usual New redness or swelling New / increased discharge or smell Unexplained increase in blood glucose Flu like symptoms (hot / shivery)   If you notice any of the above, contact your GP straight away. Explain that you have a diabetic emergency. Outside of normal hours, call the Out of Hours GP or go to A&E.

Urgent referrals to NHS Podiatry Ulceration +/- infection Red Hot Foot Fax to HCT Podiatry Have we answered your burning questions Evaluation Tel 01582 711544 Fax 01582 765537 www.hct.nhs.uk/our-services/podiatry-service/

Non urgent referrals to NHS Podiatry On going specialist foot care Callus and corns in people at risk Nail care for those at risk Tel 01582 711544 Fax 01582 765537 www.hct.nhs.uk/our-services/podiatry-service/ The NHS provides a comprehensive service for those who’s feet are at risk. Don’t attempt to treat corns and callus with blades or medicated corn plaster If people require on going podiatry care – nails hard skin corns or if Complete application form from HCT website and send to podiatry