1. Prevention of Amputation
Carolyn Wareham
Podiatry Diabetes Specialist Practitioner

2. 1-4% of people with diabetes will develop an ulcer per year
Approximately 58% of DFU patients will become clinically infected.
The number of diabetes-related amputations in England has now reached an all-time high of 20 a day
1-4% of people with diabetes will develop an ulcer per year Leese et al
According to a study published by the Eurodiale study group 3, approximately 58% of DFU patients will become clinically infected.
Amputation rate is on the rise: Public Health England data suggests there are about 7,370 amputations a year, compared to the previous figure of 7,042, according to Diabetes UK.

3. Individuals with diabetic foot ulcers have a 50% chance of mortality in 5 years
Early diagnosis and early intervention by an MDT approach can achieve good outcomes
Studies have shown that individuals with diabetic foot ulcers have a 50% chance of mortality in 5 years ( Young 2012)
This is the down side but we want to show you 2 case studies to show how good multi-disciplinary team working can prevent and reverse this sober picture

4. Case Study One Red Hot swollen Foot

5. Case Study One

6. Learning Points
Any red, hot, swollen feet – consider Charcot until ruled out
Refer early to MDT
Early diagnosis helps prevents deformity
A diagnosis of Charcot is a life changing event for the patient

7. Case Study 2 Complex Foot Ulceration

8. Case Study 2

9. Learning Points Early referral to podiatry and the MDT
It takes a team to heal an ulcer
Patients with a history of foot ulcer have a 50% risk of re-ulceration
People with diabetes have a 50% risk of reulceration within 1 year ( Maciejewski et al 2004)

10. MDT capacity is currently limited
Podiatry has a tiered approach to match podiatry need to risk classification
MDT capacity is currently limited
West Hertfordshire 16 appointments per week
East Hertfordshire 28 appointments per week
Multidisciplinary team working is essential for
When people with a foot attack get rapid access for treatment by a specialist multi-disciplinary team this has been shown to promote faster healing and fewer amputations, saving money and lives.
25 sites across Herts
5 MDT clinics
WGH- 6 appt slots
HHGH - 10 appt slots
Lister - 16 appt slots
QE appt slots
HCH - 2 appt slots

11. A Diabetic Foot Ulcer requires a team
Diabetologist
The Patient
Paediatric Consultant
Practice Nurse
Diabetic Team
Diabetes Specialist Nurse
District Nurse
G.P.
Dieticians
Tissue Viability Nurses
Orthotist
We are all part of that multidisciplinary team and each have a role for the care of these complex patients
Podiatrists
Orthopaedic Surgeon
Pharmacist
Radiologist
Microbiologist
Vascular Surgeon

12. How to refer to NHS Podiatry
Wound / Ulceration
Red Hot Foot
Urgent Fax to HCT Podiatry
Have we answered your burning questions
Evaluation
Tel
Fax
HCT Podiatry does not provide home visits

13. When to refer to podiatry
Ongoing specialist foot care
Callus and corns in people at risk
Nail care for those at risk
Hertfordshire Podiatry Service
Harpenden Memorial Service
Carlton Road
Harpenden
AL5 4TA
Tel
The NHS provides a comprehensive service for those who’s feet are at risk.
Don’t attempt to treat corns and callus with blades or medicated corn plaster
If people require on going popdiatry care – nails hard skin corns or if
Complete application form from HCT website and send to podiatry