Leading podiatry expert calls for more to be done to reduce foot amputations

by Barbara Hewitt on December 25, 2017

Diabetic foot care should be prioritised to reduce the number of avoidable amputations that can have a devastating impact on the lives of patients and their families, according to a leading expert.

Every day, 23 people with diabetes in England will have a toe, foot or leg amputated and a third of these are major amputations, meaning that the patient loses their whole foot above the ankle or even more of their leg.


Many of these amputations are preceded by diabetes-related foot ulcers, caused by a combination of impaired circulation and nerve damage, common problems experienced by people with diabetes.

But experts at the College of Podiatry point out that by improving the way diabetic foot health is commissioned and delivered, around half of these life shattering surgeries could be avoided.

It has revealed a post code lottery where amputation rates vary enormously from region to region and it wants healthcare commissioners to take note and improve the outcomes for people with diabetes.

According to Dr Paul Chadwick, consultant podiatrist and clinical director of the College of Podiatry and a leader in the field of diabetic foot care, the stark differences in amputation rates between regions signify a deep human cost for patients and their families as well as a huge cost burden for the National Health Service (NHS).

‘It is time for commissioners to increase investment in foot protection, to make sure we reduce these unnecessary and appalling personal and financial costs for patients and the NHS,’ he said.

There are an estimated 4.6 million people with diabetes in the UK and it is the most common cause of lower limb amputations and a person with the condition is around 23 times more likely to have an amputation compared to the general population.

Both lower limb amputation and foot ulceration are associated with high mortality. Only around 50% of patients survive for two years after major amputation in diabetes and the five-year survival rate after a diabetic foot ulcer is only 58%.

The College pointed out that examples of good practice do already exist across the country. In 2012, the South West had some of the highest amputation rates in England. Changes resulted in a significant reductions in the number of major amputations carried out between 2013 and 2016.

This included creating community podiatry clinics, appointments within 24 hours for people with active foot disease and direct referral to the Multidisciplinary Foot Service (MDFS) where necessary. Community podiatrists received specialist training and in Somerset the major amputation rate is now below the England average.

‘Getting diabetic foot care right for people and their families is an essential part of improving lives and preventing avoidable limb loss. People not only lose limbs, they can lose their livelihoods, their independence and sometimes also their life. By working with the College of Podiatry, we want to support the workforce to ensure a positive change in the landscape of diabetes foot care right across England,’ said Beverley Harden, Allied Health Professions lead at Health Education England.

The opinions expressed in this article do not necessarily reflect the views of the DiabetesForum.com Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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