1. Prevention of Amputation
Caroline Leith
Team Leader

2. 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.

3. 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

4. Case Study One Red Hot swollen Foot

5. Case Study One

6. 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

7. Case Study 2 Complex Foot Ulceration

8. 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.

9. 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
QE 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.

10. 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

11. Increased Diabetic Feet
Your feet have been assessed as being at increased risk of developing diabetic foot complications.
Podiatry Head Office: (Mon – Fri – 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.

12. Urgent referrals to NHS Podiatry
Ulceration +/- infection
Red Hot Foot
Fax to HCT Podiatry
Have we answered your burning questions
Evaluation
Tel
Fax

13. 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
Fax
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