Angela Flanagan

Specialist Podiatrist

Diabetic Foot Training

18th July 2019

What is Podiatry

Diabetes Podiatry Department

Diabetes

Diabetes In Rotherham1

• 2016/2017 15,509 people over age of 17 years old

diagnosed with diabetes

• This equals 7.4% of the population

• It’s estimated however the prevalence is higher

around 8.9% including non diagnosed

NICE Guidelines 20192

• Diabetes is 1 of the most common chronic diseases in the UK and its prevalence

is increasing.

• 2013, there were almost 2.9 million people in the UK diagnosed with diabetes.

By 2025, it is

• estimated that more than 5 million people in the UK will have diabetes.

• In England the number of people diagnosed with diabetes has increased by

approximately 53% between 2006 and 2013,

• from 1.9 million to 2.9 million. The life expectancy of people with diabetes is

shortened by up to15 years, and 75% die of macrovascular complications.

• The risk of foot problems in people with diabetes is increased, largely because

of either diabetic neuropathy (nerve damage or degeneration) or peripheral

arterial disease (poor blood supply due to diseased large- and medium-sized

blood vessels in the legs), or both.

• Peripheral arterial disease affects 1 in 3 people with diabetes over the age of 50,

and can also increase the risk of heart attack and stroke. For more information,

see the NICE guideline on lower limb peripheral arterial disease.

• Estimated that 10% of diabetics will develop diabetic foot ulcer

• Diabetes most common cause of non-traumatic limb amputation with diabetic

foot ulcers preceding 80% of amputations

• After first amputation twice as likely to have subsequent amputations

• Up to 70% of people die within 5 years of having an amputation and 50% dying

within 5 years of developing a foot ulcer

• Foot problems in people with diabetes have a significant financial impact on the

NHS through primary care, community care, outpatient costs, increased bed

occupancy and prolonged stays in hospital. A report published in 2012 by NHS

Diabetes estimated that around £650 million (or £1 in every £150 the NHS

spends) is spent on foot ulcers or amputations each year.

neuropathy • Long term complication of diabetes affecting nerves

• Caused by interruption to blood flow to the nerves

• Sensory, Autonomic and Motor

• Neuropathy can lead to ulceration

Sensory neuropathy3

• Affects the nerves that carry messages of touch, temperature, pain and other sensations

from the skin, bones and muscles to the brain.

• Mainly affects the nerves in the feet and the legs, but people can also develop this type of

neuropathy in their arms and hands.

• Symptoms can include:

Tingling and numbness

Loss of ability to feel pain

Loss of ability to detect changes in temperature

Loss of coordination – when you lose your joint position sense

Burning or shooting pains – these may be worse at night time.

• Risk of ulceration from walking barefoot, sharp object in shoes, ill fitting footwear and burns

Neuropathic ulceration4

Autonomic neuropathy3

• Affects nerves that carry information to your organs and glands. They help to control some

functions without you consciously directing them, such as stomach emptying, bowel control,

heart beating and sexual organs working.

• Damage to these nerves can result in:

• Gastroparesis – when food can’t move through the digestive system efficiently. Symptoms

of this can include bloating, constipation or diarrhoea

• Loss of bladder control, leading to incontinence

• Irregular heart beats

• Problems with sweating, either a reduced ability to sweat and intolerance to heat or

sweating related to eating food (gustatory)

• Impotence (inability to keep an erection).

Motor Neuropathy3

• affects the nerves which control movement. Damage to these nerves leads to

weakness and wasting of the muscles that receive messages from the affected

nerves. This can lead to problems such as:

• muscle weakness, which could cause falls or problems with tasks such as

fastening buttons.

• muscle wasting, where muscle tissue is lost due to lack of activity

• muscle twitching and cramps.

Daily foot checks for Diabetic

patients in hospital should be

carried out (this is audited)

Foot Checks • Remove footwear and socks

• Remove dressings

• Check feet visually including between toes

• Look for foot deformity

• Look for callus that could potentially cause a problem

• Look for any evidence of fluid or tracking of fluid

Check feet

Diabetes and circulation

Poor Circulation

Posterior

Tibialis

Dorsalis Pedis

Poor Circulation5

Charcot arthropathy6

• Charcot foot is a type of bone deformity that can lead to serious damage and

disability.

• Increased risk of developing this if you have neuropathy and balance problems.

• Often patients will continue to walk on the damaged foot due to not feeling it.

• Often mistaken for infection.

• Symptoms of Charcot foot may include:

Swelling or redness of the foot or ankle

Skin feeling warmer at the point of injury

A deep aching feeling

Deformation of the foot

Charcot Foot7

Risk Category2

• Low risk:

• no risk factors present except callus alone.

• Moderate risk:

• deformity or

• neuropathy or

• non-critical limb ischaemia.

• High risk:

• previous ulceration or

• previous amputation or

• on renal replacement therapy or

• neuropathy and non-critical limb ischaemia together or

• neuropathy in combination with callus and/or deformity or

• non-critical limb ischaemia in combination with callus and/or deformity.

INFECTION: Never underestimate it!

Classical Signs? 8

• Never walk barefoot

• When at home use a slipper to

help protect your feet from

trauma/foreign bodies

• Make sure your slippers are

of the correct size and are

supportive of your feet

• Use slippers while in hospital

Slippers

• Wear socks when your

using shoes

• Don’t use socks with

tight elastic tops

• If there are thick seams, turn

your socks inside out

• Examine your white socks for

any discharge or blood

Socks

References 1 https://fingertips.phe.org.uk/profile-group/cardiovascular-disease-diabetes-kidney-

disease/profile/cardiovascular/data#page/13/gid/1938133106/pat/46/par/E39000048/ati/152/are/E38000141

2 https://www.nice.org.uk/guidance/ng19/chapter/1-Recommendations#charcot-arthropathy-2

3 https://www.diabetes.org.uk/Guide-to-

diabetes/Complications/Nerves_Neuropathy?gclid=EAIaIQobChMI4Zjj6sPD2gIVTUPTCh2VsgdZEAAYASAAEgK4c_D_BwE

4 https://thoracickey.com/lower-limb-ulceration/

5 http://www.emed.ie/Metabolic/Diabetic_Foot.php

6 https://www.diabetes.co.uk/diabetes-charcot-foot.html

7 http://www.drwolgin.com/charcot-fractures/

8 Armstrong DG, Lavery LA and Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection

and ischemia to risk of amputation. Diabetes Care. 1998; 21(5): 855-859.

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