Avoidable diabetes-related amputation

Leading diabetes charity, Diabetes UK, recently revealed that the number of diabetes-related amputations in England has reached an all time high of 20 a day. That’s 7,370 diabetes-related amputations a year of which they believe four out of five could have been prevented.

Their estimate of the number of preventable amputations is based on the fact that 80% of these began with foot ulcers, a condition which is both avoidable and treatable. In diabetics, however, the first signs of foot ulcers can often go unrecognised and untreated until it is too late to avoid the loss of the foot or leg.

The charity is calling upon the government and the NHS to do more to tackle this problem by improving foot-care for people with diabetes. All diabetics need to have regular access to trained healthcare professionals, foot-care specialists and multi-disciplinary foot-care teams to ensure that foot problems are identified and treated early.

Diabetes is related to a number of other conditions, such as thyroid disease, coeliac disease, increased dental problems and muscular conditions like Dupuytren’s contracture or frozen shoulder. It also has serious complications of its own, such as hypoglycaemia, retinopathy and blindness, cardiovascular disease, nephropathy (kidney damage) and neuropathy (nerve damage). Not all diabetics will suffer these complications but they are at increased risk if they smoke or do not manage their condition by controlling their blood pressure, blood glucose and blood fat levels, maintaining an ideal body weight and keeping active.

Diabetics are at greater risk of foot problems which can potentially lead to amputation because diabetes reduces sensation and blood circulation in their feet. Most people would immediately notice a blister on their foot and take steps to protect the skin and allow it to heal. In the same circumstances, someone with diabetes may be unaware of the blister as they have reduced sensation in their foot. If they do not check their feet daily, without proper care the blister can become infected and develop into an ulcer which then becomes more difficult to treat.

Good management of diabetes is essential to reduce the risk of serious complications. This must include good foot care and regular check-ups. With reduced sensation in their feet, diabetics should make visual foot checks part of their regular daily routine, asking for help with their checks if they suffer from eyesight problems. They should be particularly vigilant in looking out for the following signs of potential foot-care problems:

• Minor cuts to the feet
• Blisters
• Redness, warmth and swelling in the feet
• Discharge or fluid oozing from the foot into socks or tights
• Generally feeling unwell

If any of the above are present, they should see their GP immediately. Treatment may include:

• Antibiotics
• Resting the foot
• A review of their diabetic medication and management.
• Referral to a foot-care specialist
• A personal care plan

Despite the rising numbers of diabetes-related amputations, with an estimated eight out of ten of all diabetic related amputations being avoidable,  there is still hope that with increased awareness and improvements in care the tide can be turned and the statistics reduced for the future.

Amputation can have a devastating impact on a person’s life, affecting their ability to work, drive, look after their personal care and participate in family and social activities as well as affecting their psychological well-being and self esteem.

Boyes Turner’s medical negligence specialists are currently pursuing claims for two clients who have undergone amputations following delayed medical diagnosis of Charcot foot. This serious limb-threatening condition is a complication of diabetic neuropathy which can lead to bone deformity, disability and amputation if untreated. Charcot foot can be triggered by a sprain or twisted ankle which goes unnoticed owing to reduced sensation. As the person continues to walk and puts additional pressure on the foot, further damage is caused.

Symptoms of Charcot foot may include:

• Swelling or redness of the foot or ankle
• The skin feeling warmer at the point of injury
• A deep aching feeling
• Deformation of the foot

Treatment should involve:

• Reducing pressure (or weight-bearing) on the foot
• A plaster cast to allow the foot to set and heal in the correct position
• Regular continuing appointments with a podiatrist
• X rays to monitor the condition

Boyes Turner secured £210,000 for a 70 year old man with diabetic peripheral neuropathy who needed a below-knee amputation after attending hospital and his GP surgery with a minor cut on his foot. His wound was dressed in hospital and he was given antibiotics but when he later visited his GP practice a nurse practitioner decided to treat his foot conservatively. By the time he went back to A&E for further advice the infection had spread causing damage which resulted in a below knee amputation.