1. Diabetes and Feet: Everything you need to know!
JACLYN GLAZEBROOK
ADVANCED PODIATRIST: DIABETES
Nottingham University Hospitals –
Dundee House, City Hospital

2. What do you need to know? Why all the fuss?: Facts and Figures
How does diabetes affect the feet?
Neuropathy
Peripheral Arterial Disease
Other Risk Factors
What do we do when we find a problem?
= Podiatry & MDFT Referral

3. So…what’s all the fuss about the diabetic foot?
Facts & Figures…

4. The Human Cost…

5. The Human Cost… 80% of amputations are PREVENTABLE
>1 in 10 of these people will go on to have an amputation of some form
England 2016: More than 135 amputations a week in people with diabetes
1 in 6 (17%) die within a year, 78% in 5 years
Only 50% of people who have had amputation survive for 2 years
80% of amputations are PREVENTABLE

6. £1 in every £150 spent in NHS The Financial Cost…
Diabetes Foot Ulcers and Amputations in NHS England (2012)
£ million in
£1 in every £150 spent in NHS
Equates to 0.7% of total NHS budget
£ million: primary/outpatient care
£ million: inpatient care/A&E
£76 million: post amputation care

7. But what does that mean to me? Nottingham: 2012 - 2015
Inpatient Care
Episodes Inpatient
Care
Nights spent
in hospital
Episodes of care
amputation occurred
Nottm NE CCG
474 (244 pts)
4278 70
Nottm West CCG
278 (121 pts)
2301 30
Rushcliffe CCG
309 (134 pts) 31
Nottm City CCG
1095 (471 pts)
8952
139
South Notts
2156 (970 pts)
17832
270
England
167,224
1,357,714
22109

8. But what does that mean to me? Nottingham: 2012 - 2015
Major Amputations
Minor Amputations
Total
No.
Per 1000 people with DM
Compare
Per 1000
People
with DM
Compare
Nottm NE CCG 17
0.8
↓ 24% 53
2.3
↑ 90%
Nottm West CCG 8
0.6
↓ 22% 22
1.5
↑ 114%
Rushcliffe CCG 7
0.4
↓ 46% 24
↓ 27%
Nottm City CCG 38
↑ 24%
101
2.2
↑ 65%
South Notts 70
200
England
6821
15,288
1.8

9. Diabetes Foot Problems =
And in clinical terms…
Diabetes Foot Problems =
Most common reason for hospital admission for people with diabetes
Longest episodes of inpatient care for people with diabetes
Increase in Multi Drug Resistant Organisms
Increase in Hospital Acquired Infections
Major Long-Term Impact on Quality of Life

10. Risk Factors for Developing Diabetic Foot Complications:
So…how does diabetes affect the feet…In real terms
Risk Factors for Developing Diabetic Foot Complications:
Peripheral Neuropathy Peripheral Arterial Disease Significant structural deformity Skin changes/significant callus
Previous ulceration/amputation Inability to self care Poorly fitting footwear Chronic Kidney Disease

11. Peripheral Neuropathy…
Damage to the peripheral nervous system
High blood glucose damages small blood vessels that feed the nerves
A sufficient supply of nutrients and oxygen no longer reaches the nerve, causing the nerve to become damaged and eventually die
Affects between 20-40% of people with diabetes

12. Peripheral Neuropathy affects…
Sensory Nerves – Transmit pain, temperature & touch
Many
Many people who have sensory neuropathy often have no symptoms and are often unaware of it’s presence
damage causes:
Reduced sensation Pins and needles
Reduced awareness of pain Burning
Reduced awareness of hot and cold Numbness
= Loss of Protective Sensation
(sensory neuropathy)

13. Loss of Protective Sensation?

14. What else can’t they feel???
Ouch???
Able to pass sterile probe through connecting ulcers without feeling it!
What else can’t they feel???

15. Peripheral Neuropathy affects…
Motor Nerves
Carry impulses from the brain & spinal cord to muscles
enabling movement
damage causes:
Weakness of the small muscles that maintain normal foot shape
= change to foot shape
Loss of muscle strength which affects muscle movement
= Altered Foot Shape = High pressure = Callus =Tissue Stress
= Increased Mechanical Load & Shear = Reduced Shock Absorption

16. Peripheral Neuropathy affects…
Autonomic Nerves
- Regulate sweating and perfusion to the limbs
damage causes:
Reduced sweating
Dry inelastic skin
Inhibited thermoregulatory function
= development of splits, cracks and fissures
= portal of entry for bacteria
ESSENTIAL to provide good quality emollients and advise on daily use FOREVER