Management of the diabetic foot and lower limb

Patrick ChongConsultant Diabetologist

Derriford Hospital

The diabetic foot

Definition

The diabetic foot

‘a group of syndromes in which neuropathy, ischaemia, and infection lead to tissue breakdown resulting in morbidity and possible amputation’ (World Health Organisation, 1995).

Epidemiology

• Most common cause of lower limb amputations1

• 1:20 will develop foot ulcer in one year2

• 1:20 foot ulcers result in amputation of foot or leg

• Up to 70% of patients die with five years of having an amputation

1.Amputee Statistical Database for the United Kingdom (2005)2 Diabetes Care 21 (7); 1071–1075

Economic cost

• 3.9% of population• 10% of NHS budget1

• Prolonged stays in hospitals• Patients with complications 5 x more likely

to be admitted to hospital• Presence of complications increase social

services cost by 4 x

1 Department of Health (2006). Turning the corner improving diabetes care

Gruesome threesome

• Neuropathy• Ischaemia• Excess pressure loading

– Reduced joint mobility– Local deformity

MDT working

• Accurate diagnosis• Rapid appropriate treatment• Intensive follow up• Prevention of foot lesions

Prevention

• Education– 1:3 people with diabetes do not realise

increased risk of amputation1

• Regular screening• Risk stratification• Joint foot clinic

1 MORI poll for Diabetes UK September 2007

Local figuresYear

01020304050607080

1999 2000 2001 2002 2003 2004 2005 2006 2007

year

Year Total AKA BKA Foot1999 55 10 (18%) 19 26 (47%)2000 72 14 (19%) 19 39 (54%)2001 61 20 (33%) 21 20 (33%)2002 53 9 (17%) 16 28 (53%)2003 60 10 (17%) 12 38 (63%)2004 70 13 (19%) 19 35 (50%)2005 44 6 (14%) 13 25 (57%)2006 75 7 (9%) 16 52 (69%)2007 61 7 (11%) 20 34 (56%)

Trends in amputation

0

10

20

30

40

50

60

70

80

1999 2000 2001 2002 2003 2004 2005 2006 2007

Percentage AKA

Foot