Improving diabetic foot care

4th February 2013

People with diabetes across Scotland are to receive new feet checks in hospital as the latest figures reveal over 1,350 Scots have lost a leg due to the illness.

Diabetes is the leading cause of lower-limb amputation as it reduces the amount of blood reaching the feet, leading to a loss of sensation and gangrene. In the vast majority of cases, however, it can be avoided.

The new checks, known as �CPR for Feet�, aim to identify patients with a foot ulcer or those at risk of developing them. Patients will be offered the checks at hospital and foot clinics.

Visiting a foot clinic at the Southern General today, Minister for Public Health Michael Matheson said:

"Diabetes is a growing problem for Scotland � we know at least �300 million of hospital expenditure relates to diabetes treatment and the management of its complications. Even more is spent on the rehabilitation and care needed after amputation.

"The impact of having a limb amputated can be devastating and can dramatically change someone�s life. However in many cases this is avoidable.

�That is why we are so committed to ensuring that people with diabetes have access to the best possible care so that the risks of amputation are minimised. The diabetes community have already made great progress - more people than ever before are now getting their feet checked and access to the care and support they need.

�The new �CPR for Feet� programme will offer new foot care checks in hospital to everyone with a diagnosis of diabetes to determine their risk of developing foot disease, and gives them the information and support that they need to reduce that risk.

�This work will ensure that more people with diabetes get access to the care they need

�We are also maintaining a focus on preventing diabetes by tackling the underlying risk factors. Stopping smoking, eating better and taking regular exercise is something we can all do to make sure we are as healthy as possible."

Linda McGlynn, Diabetes UK Scotland�s National Care Advisor said:

�Any amputation is devastating for individual patients and so further reductions in both minor and major amputations in Scotland would be very welcome. It shows how important foot care and annual foot checks can be in contributing towards a better quality of life.�

The new campaign is welcomed by Mr Iain Bone from Darnley, Glasgow, who is urging everyone with diabetes to take care of their feet.

In September 2010, Iain, 48, had surgery to remove two toes and improve the blood flow to his foot, without which clinicians say he would have lost his foot.

Iain was diagnosed with diabetes 18 years ago and has experienced multiple complications since, including serious damage to his nerve system and infected ulcers on his feet.

As a result, two years ago doctors told him that he needed a minor amputation and an operation to bypass a blocked artery in his leg in order to save his foot.

Iain said:

�One morning I woke up and noticed an ulcer on my heel. I went to the chiropodist straight away and they tried to get it to heal over the next few weeks. However it just won�t heal due to the lack of a blood supply in the foot caused by my diabetes.�

Soon Iain developed a second ulcer on his foot, which was not healing either and both ulcers became infected.

He said: �It was explained to me that I needed a bypass surgery in order to allow better flow of blood to my feet and unfortunately due to the infection in the two toes both had to be removed.�

�Having two toes removed was a much better outcome that where I was heading at that point. I�m just so pleased that everything is back on track.�

While he can no longer play golf due to some balance problems, saving his foot has allowed him to remain at work as a paralegal, which greatly values.

Talking about the importance of continuing to manage his foot care, Iain said: �I now check my feet every day because now I know the signs to look for.

�I also get check regularly by the team here at the diabetes foot clinic. It gives me peace of mind to know that if something did start to go wrong again, the health staff would get it quickly and help it heal. If I was to leave it I could face amputation of the foot or worse even, of the leg from the knee down.

�Things are a lot better now that they could have been and I want to keep it that way.�

The CPR Training Manual encourages all ward staff to

Check - When a patient with diabetes is admitted to hospital their feet should be checked for any existing foot ulcers.

Protect - If a patient has had a previous foot problem or is at risk of developing a foot problem care should be taken to protect the patient�s feet.
Refer - Patients who have a current foot ulcer and those at high risk of developing a foot ulcer during their stay in hospital should be referred to the Podiatry Department
People with diabetes are 15 times more likely to need an amputation than the general population.