By 2025 it is estimated that more than 5 million people in the UK will have diabetes. According to Diabetes UK, there have been 26,378 diabetes-related lower limb amputations in the last three years. The statistics relating to diabetes-related amputations are alarming and, unfortunately, are rising every year. However, with good foot care and correct medical management diabetic foot problems can be treated successfully. Limb loss in people who have diabetes is often preventable. As amputation claims lawyers, we have seen for ourselves the physical, psychological and financial impact that amputation has had on our amputee clients’ lives. We know from experience the vital role of good foot care and regularly raise awareness of how important it is that diabetics know how to look after their feet and when to seek medical attention. Correct medical management can be the difference between keeping and losing a limb, so it is vitally important that doctors treat diabetic foot problems properly. Why are people with diabetes at greater risk of amputation? According to Diabetes.co.uk, people who have diabetes are 15 times more likely to undergo amputations than other people without the condition. There are a number of reasons for this. Diabetic patients can experience diabetic neuropathy which can cause loss of feeling in the feet, tingling and/or pain. This is the result of high blood glucose levels damaging the small blood vessels which supply the nerves. Someone with numbness may not feel if their foot is injured and this can be left untreated. Nerve damage and high blood sugar levels also mean that foot injuries take much longer to heal and result in foot ulcers or infection. Vascular problems are also more common in people with diabetes. High blood sugar levels can lead to a narrowing of blood vessels and peripheral arterial disease. In turn this can cause poor blood circulation. This means that wounds heal more slowly and so there is a greater risk of infection or foot ulcers. Charcot foot is a less common complication of diabetes, although incidences of this are rising. Charcot foot is caused by a combination of factors. If a person suffers an injury such a sprain but, due to neuropathy, does not feel this, they can continue to walk on the foot and this can lead to fractures and/or dislocations. The foot can become deformed, with the person therefore walking on the side of their foot, leading to the development of foot ulcers. The bones in the foot can also become infected. How should a foot ulcer be treated? The National Institute for Health and Care Excellence (NICE) has produced guidelines for health professionals relating to the treatment of foot injuries in those who have diabetes, including the latest ‘Foot care for people with diabetes’ pathway in March 2019. Healthcare professionals therefore have resources to aid them in treating diabetic foot problems. Diabetic patients should be assessed for their risk of developing a diabetic foot problem at least annually. They are then placed into a risk category. This will determine when their next appointment with the foot service should be. If a diabetic person has any form of ulceration, or if there is concern that they could have an infection or gangrene, they should be referred within one working day to the multidisciplinary foot care service or foot protection service for triage within one further working day. If a person is suspected to have a life-threatening or limb-threatening foot injury they should be referred to the multidisciplinary foot care team within 24 hours. Once a foot ulcer is detected, treatment may include: offloading (relieving the pressure on the foot), control of infection and ischaemia (reduced blood/oxygen supply) to the affected area, wound debridement and/or wound dressings. It is important that the appropriate steps are taken and that these are carried out correctly. Poor wound dressing, for example, can cause more problems than it solves. There is specific NICE guidance on this as well. Choosing the correct dressing and fitting this optimally to aid healing is essential. The aim is to treat the wound so that it heals and amputation is avoided. Unfortunately once one limb has been amputated there is a higher chance that the patient will require a further amputation at a later date. How can people with diabetes look after their feet to prevent foot problems and amputation? Prevention is always better than cure. If a person has diabetes it is really important that they know how to look after their feet to prevent, detect and treat minor injuries before these develop into more serious problems. The NHS has some good tips for diabetic patients on taking care of their feet, including: Regularly inspecting feet Good diabetes control Seeing a podiatrist regularly Ensuring feet are clean Wearing shoes that fit well Never walking barefoot (especially in the garden or on the beach) Cutting toenails regularly Treating hard skin Stopping smoking Eating a healthy, balanced diet What type of medical negligence claims arise from diabetes and amputation? We commonly act for diabetic amputees in medical negligence claims arising from failings in care by their GPs. These claims often relate to amputation caused by the GP’s failure or delay in referring and treating a diabetic patient with a foot injury, infection or suspected vascular disease, or failure to recognise and treat Charcot foot. Claims can also be made against hospitals where treatment has been incorrectly carried out or delayed resulting in worsening infection (such as gangrene), ischaemia and amputation. Where we are able to prove that a GP or hospital’s negligent delay or treatment error was the cause of our client’s amputation, we recover early interim payments and full compensation to meet the cost of: rehabilitation wheelchairs and adapted vehicles bespoke prosthetics care and assistance therapies, such as physiotherapy and occupational therapy (OT) adapted accommodation specialist equipment replacing loss of earnings private medical care or additional surgery psychological counselling other expenses caused by their disability If you or a member of your family have suffered or are expecting to undergo amputation as a result of medical negligence, contact us by email at mednegclaims@boyesturner.com.
