Service redesigns, better referral pathways and increased access to specialist diabetes services in community settings are required to help prevent serious foot infections, lower limb amputations and premature death, warn leading podiatrists from the Royal College of Physicians and Surgeons of Glasgow’s Faculty of Podiatric Medicine.
At the end of 2016, there were 291,981 people diagnosed with diabetes in Scotland – 5.4% of the population. This represents a 39% increase since 2007, and presents a particular challenge for Foot Protection services across Scotland as the number of patients with foot problems continues to rise.
Speaking on World Diabetes Day (Tuesday 14 November 2017), Professor Robert Ashford, Dean of the College’s Faculty of Podiatric Medicine highlighted the issue, and called for converted action to address this growing problem.
Professor Ashford said:
“Foot complications are common in people with diabetes. It is estimated that 10% of people with diabetes will have a diabetic foot ulcer at some point in their lives. A foot ulcer can be defined as a localised injury to the skin and/or underlying tissue, below the ankle, in a person with diabetes.
“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.
“There has been a significant reduction in the incidence of lower extremity amputation in persons with diabetes in Scotland between 2004 and 2008, principally explained by a 41% reduction in major amputation. (Kennon et al 2012).
“Although the role of podiatry in the prevention of lower limb amputations cannot be quantified, both the SIGN guideline 116 and NICE guideline 19 recommend that rapid access to appropriately skilled podiatrists in foot protection clinics and multi disciplinary teams is a vital component in improving amputation rates.
“NHS podiatry services need to respond to this challenge by continuing to redesign their services in order to direct their limited resources to ensure that all active diabetic foot problems are referred to the multidisciplinary foot care service or foot protection service (according to local protocols and pathways) for triage within 2 working days.
“Community based foot protection services should be led by podiatrists with specialist training in diabetic foot problems, and should have access to healthcare professionals with skills in diabetology, biomechanics and orthoses, wound care.”