Diabetes, foot care and amputation factsheet
• Diabetes is the single most common cause of lower-limb amputation in the UK.
• Every 30 seconds a leg is lost due to diabetes somewhere in the world.
• More than one in ten foot ulcers in people with diabetes result in an amputation, meaning people with diabetes are between 15 and 30 times more likely to have an amputation than those without.
• £600m each year goes on treating foot problems in people with diabetes in the UK, and at least £252m of this is spent on amputation.
• One in three people with diabetes do not realise that having the condition puts them more at risk of having an amputation.
• People with Type 1 and Type 2 diabetes are at risk of damage to the nerves (neuropathy) and blood supply (ischaemia) to their feet. Both neuropathy and ischaemia can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputation. However, researchers estimate that between 49 per cent and 85 per cent of all diabetic amputations can be prevented.
What is diabetes?
Diabetes is a life-long condition where the amount of glucose in the blood is too high because the body cannot use it properly. This is because either the pancreas does not produce any or enough insulin, to help glucose enter the body’s cells, where it is used for energy, or the insulin that is produced does not work properly (known as insulin resistance).
There are two main types of diabetes: Type 1 and Type 2
Type 1 diabetes develops if the body is unable to produce any insulin and usually appears before the age of 40, and especially in childhood. It is treated by insulin either by injection or pump, a healthy diet and regular physical activity.
Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly. It usually appears in overweight people over the age of 40, though in South Asian and Black people often appears from the age of 25. It is also becoming increasingly more common in children and young people.
The main aim of treatment of both types of diabetes is to achieve blood glucose, blood pressure and blood fat levels as close to the target ranges agreed with the healthcare team. This together with a healthy lifestyle will reduce the chances of developing the long-term complications of diabetes such as blindness, heart disease, amputation, kidney failure and nerve damage.
Why is foot care important to people with diabetes?
Foot problems can affect anyone who has diabetes. People with diabetes are at risk of nerve damage (neuropathy) and problems with the blood supply to their feet (ischaemia). Both neuropathy and ischaemia can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputation.
By keeping blood glucose, blood fats and blood pressure under control people with diabetes can help to prevent complications associated with the feet.
Researchers estimate that between 49 per cent and 85 per cent of all diabetes-related amputations can be prevented through good foot care.
What should people with diabetes do to look after their feet?
People with diabetes should:
• Not expose their feet to extremes of heat or cold.
• Make sure they wear shoes and socks that are well fitting.
• Check their feet daily (see danger signs to look out for below).
• Wash their feet every day with ordinary soap and warm water, drying them carefully – especially between the toes.
• Use a moisturising cream for dry skin.
• Cut their toenails to the shape of the end of your toes about once every six to eight weeks.
• Always wear footwear – even at home. It can be possible for them to damage their feet without knowing.
Danger signs to look out for
People with diabetes should check their feet every day and report any changes to their doctor, nurse or podiatrist. If a person finds it difficult to check their own feet they should ask a friend or relative to help.
• Sores and cuts that do not heal.
• Bright pink or red skin – if your skin is white; brown or black skin if you have darker skin
• Puffiness or swelling.
• Difficulty in moving parts of the foot.
• Skin that feels hot to the touch.
• Weeping pus.
• Pain in the feet or legs.
People with diabetes with any of the above symptoms should seek immediate urgent care from their GP or healthcare professional.
What to expect at a foot examination
People with diabetes should have their legs and feet examined by a healthcare professional at least once a year.
The healthcare professional will ask questions about the person’s feet, their diabetes and their health in general and a number of pain free tests will also be carried out. These include:
• Neuropathy testing – the examiner will press a series of instruments on their toes and the balls of their feet to check for numbness. He/she will also test the person’s reflexes and may check whether they can feel the difference between hot and cold.
• Circulation testing – the examiner will feel the pulses the person has in their feet and legs and equipment might be used to listen to the sound of the blood moving in the arteries of their legs and feet. The person may also have the blood pressure of their legs taken.
• Foot inspection – feet will be checked for any corns, calluses and nail problems.
Visit the Diabetes UK website – www.diabetes.org.uk or call the Diabetes UK Careline on .0845 120 2960 for further information or advice on diabetes and maintaining healthy feet.