In our new Wound Management course, the focus is firmly on chronic wounds and with good reason. Venous, arterial, pressure and diabetic foot ulcers cost the NHS over £4 billion and are a source of pain and debilitation for at least 200,000 patients each year. (1) It’s crucial that we use up-to-date, research-based methods and products when treating these wounds but the importance of preventing their development in the first place should not be underestimated.
With this in mind, Diabetes UK launched their campaign Putting Feet First. It’s been highly successful in raising awareness of diabetic foot ulcers and has been credited with increasing the number of specialist foot care teams available in the NHS. But foot care should be routine for people living with diabetes and so, for the nurses and healthcare assistants in the community and social care, foot inspections should be part of their arsenal against diabetic ulcers.
Why does diabetes make people more susceptible to foot ulcers?
There are almost 3.7 million people living with diabetes in the UK and due to lifestyle changes, this figure is set to rise. The raised blood glucose levels that diabetics can experience, cause damage to blood vessels and if this happens in the retina, kidneys and peripheral nerves, it may eventually lead to blindness, kidney failure or neuropathy. In addition, high blood sugars also hinder the normal immune system response, making infections more likely and difficult to fight.
Now, imagine you have a tiny stone in your shoe. You take a few steps, wince, kick your foot about to try and shift it and when that fails, take your shoe off and shake the stone out. Problem solved!
But if you have neuropathy with reduced sensation in your feet, you walk about all day and don’t even realise the stone is there. But it is there and after a day of continuous pressure, the skin has broken and you now have a small wound. Because of the damaged blood vessels, you may also have poor circulation, so the oxygen and nutrients needed to heal the wound can’t get there easily and the high blood sugars mean that infections can quickly establish themselves.
The catalogue of diabetes-related effects has led to a foot ulcer and 1 in every 10 people with diabetes will suffer this at some point in their life. The problems don’t just end with a painful and distressing wound though. Having toes, part of the foot or the lower leg amputated is a significant risk, once a chronic ulcer has developed. However, foot ulcers don’t have to be an inevitable part of diabetes.