Prevention of Amputation Carolyn Wareham Podiatry Diabetes Specialist Practitioner

1-4% of people with diabetes will develop an ulcer per year Approximately 58% of DFU patients will become clinically infected. The number of diabetes-related amputations in England has now reached an all-time high of 20 a day 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.

Individuals with diabetic foot ulcers have a 50% chance of mortality in 5 years Early diagnosis and early intervention by an MDT approach can achieve good outcomes Studies have shown that individuals with diabetic foot ulcers have a 50% chance of mortality in 5 years ( Young 2012) This is the down side but we want to show you 2 case studies to show how good multi-disciplinary team working can prevent and reverse this sober picture

Case Study One Red Hot swollen Foot

Case Study One

Learning Points Any red, hot, swollen feet – consider Charcot until ruled out Refer early to MDT Early diagnosis helps prevents deformity A diagnosis of Charcot is a life changing event for the patient

Case Study 2 Complex Foot Ulceration

Case Study 2

Learning Points Early referral to podiatry and the MDT It takes a team to heal an ulcer Patients with a history of foot ulcer have a 50% risk of re-ulceration People with diabetes have a 50% risk of reulceration within 1 year ( Maciejewski et al 2004)

MDT capacity is currently limited Podiatry has a tiered approach to match podiatry need to risk classification MDT capacity is currently limited West Hertfordshire 16 appointments per week East Hertfordshire 28 appointments per week Multidisciplinary team working is essential for 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. 25 sites across Herts 5 MDT clinics WGH- 6 appt slots HHGH - 10 appt slots Lister - 16 appt slots QE2 - 10 appt slots HCH - 2 appt slots

A Diabetic Foot Ulcer requires a team Diabetologist The Patient Paediatric Consultant Practice Nurse Diabetic Team Diabetes Specialist Nurse District Nurse 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

How to refer to NHS Podiatry Wound / Ulceration Red Hot Foot Urgent 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/ HCT Podiatry does not provide home visits

When to refer to podiatry Ongoing specialist foot care Callus and corns in people at risk Nail care for those at risk Hertfordshire Podiatry Service Harpenden Memorial Service Carlton Road Harpenden AL5 4TA Tel 01582 711544 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 popdiatry care – nails hard skin corns or if Complete application form from HCT website and send to podiatry