1. Management of the diabetic foot and lower limb Patrick Chong Consultant Diabetologist Derriford Hospital

2. The diabetic foot

5. Definition The diabetic foot ‘ a group of syndromes in which neuropathy, ischaemia, and infection lead to tissue breakdown resulting in morbidity and possible amputation’ (World Health Organisation, 1995).

6. Epidemiology Most common cause of lower limb amputations 1 1:20 will develop foot ulcer in one year 2 1:20 foot ulcers result in amputation of foot or leg Up to 70% of patients die with five years of having an amputation 1. Amputee Statistical Database for the United Kingdom (2005) 2 Diabetes Care 21 (7); 1071–1075

7. Economic cost 3.9% of population 10% of NHS budget 1 Prolonged stays in hospitals Patients with complications 5 x more likely to be admitted to hospital Presence of complications increase social services cost by 4 x 1 Department of Health (2006). Turning the corner improving diabetes care

8. Gruesome threesome Neuropathy Ischaemia Excess pressure loading –Reduced joint mobility –Local deformity

9. MDT working Accurate diagnosis Rapid appropriate treatment Intensive follow up Prevention of foot lesions

10. Prevention Education –1:3 people with diabetes do not realise increased risk of amputation 1 Regular screening Risk stratification Joint foot clinic 1 MORI poll for Diabetes UK September 2007

11. Local figures

12. YearTotalAKABKAFoot 19995510 (18%)1926 (47%) 20007214 (19%)1939 (54%) 20016120 (33%)2120 (33%) 2002539 (17%)1628 (53%) 20036010 (17%)1238 (63%) 20047013 (19%)1935 (50%) 2005446 (14%)1325 (57%) 2006757 (9%)1652 (69%) 2007617 (11%)2034 (56%)

13. Trends in amputation