Medical Negligence

A Guide to Diabetes and Foot Care

May 17, 2024
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Diabetes is one of the leading causes of lower limb amputations across the world, with the NHS reporting that diabetic patients are 15 times more likely to undergo an amputation than people without diabetes. According to Diabetes.co.uk, foot problems are the most common cause for diabetic patient hospitalisation.

The latest NHS Resolution report in 2022 highlights the increasing link between amputations and diabetes, with 7,957 diabetic lower limb amputations recorded in England between 2017 and 2020. The report also discusses delays in diabetic foot disease diagnosis and providing proper care during prevention stages as causing lower limb amputations.

However, despite the rising link between diabetes and amputation, undertaking regular foot care routines can prevent serious foot complications. Helen Vernon, Chief Executive Officer for NHS Resolution, has emphasised that 85% of diabetes and lower limb amputations are avoidable with the adequate diabetic care provided by healthcare professionals.

Ahead of Diabetes Awareness Week, Fletchers Solicitors are on a mission to raise awareness of the important measures diabetic patients can take to prevent amputation. In this guide, we’ll explain:

  • What is diabetic foot care and why it matters
  • Our diabetic foot care checklist
  • Identifying and treating foot problems early
  • The role of diet and exercise in foot health
  • Innovations in diabetic foot care
  • What to do if amputation is required and its impact to life
  • Seeking justice and compensation if your amputation was not your fault

What is diabetic foot care?

Having diabetes means that you are at a much higher risk of developing foot problems, according to Diabetes UK.

Raised blood sugar levels can lead to nerve and blood vessel damage which can, over time, lead to poor blood circulation in your feet. It can also cause a condition called peripheral neuropathy where you feel pain, numbness, or tingling in your feet.

According to the NHS, peripheral neuropathy can be caused by Type 1 or Type 2 diabetes and is one of the primary conditions that leads to diabetic amputation as the pain or lack of sensation often makes it harder for people to know that they have cuts, blisters, or an infection in their feet. “In our clients’ experience, amputation has been linked to diabetic complications which can include nerve damage and poor circulation of blood” comments Trevor Ward, Partner & Senior Solicitor.

“Therefore, diabetics who experience nerve damage, may not be able to feel the wounds, and in turn do not seek the required treatment which could prevent an amputation.”

 Diabetic foot complications can lead to the following without proper care:

  • Foot ulcers
  • Charcot foot
  • Amputation

What are the risk factors?

Diabetes.co.uk have highlighted the following as increasing the risk of foot ulcers and charcot foot:

  • Neuropathy
  • Poor blood circulation
  • Wearing poor fitting footwear
  • Walking barefoot
  • Insufficiently well controlled diabetes
  • Smoking
  • Lack of exercise
  • Being overweight
  • High cholesterol and/or blood pressure

By following a comprehensive diabetic foot care routine and keeping an eye on your blood sugar levels, you can greatly reduce the risk of foot related complications. You’ll also help to maintain your own mobility and the quality of your life.

Diabetic foot care checklist

This section details four positive steps you can take to manage your condition and stop early diabetes feet problems from developing in the first place:

1. Blood Glucose Management

Many of the health problems associated with diabetes can be managed by keeping on top of your blood sugar levels.

Use your blood glucose metre to check your levels at various times throughout the day like before and after you have a meal and before bedtime. Follow the plan your doctor recommends.

Keep a log of your blood sugar level readings and share them with your doctor. This will help them identify patterns in your condition so they can make any necessary adjustments to your treatment plan.

Take your medications as your doctor directs you whether you’re on insulin, oral medications, or a combination of both. If anything about your medication worries you or you start to experience any side effects, let them know straight away so they can find the right solution for you.

2. Daily Foot Inspection and Hygiene Practices

Each day, set aside a specific time, like before or after you take a shower or bath, to thoroughly examine your feet.

If you see any thickened skin, calluses, or corns on your feet, don’t try to remove them yourself. It’s better to ask your chiropodist instead who can safely remove them for you. If it’s difficult to see or reach the bottom of your feet, it can be useful to ask a family member, friend or health care professional for help.

Washing your feet

Feet hygiene is also majorly important for preventing infections. Use a simple combination of warm water and a mild, fragrance-free soap to clean your feet gently, ensuring the water temperature isn’t too hot to avoid scolding your skin.

When washing your feet and between your toes, make sure you clean any areas where bacteria or dirt might have built up and once you’ve finished, dry your feet thoroughly with a soft towel, particularly between your toes.

Moisture on your feet can become a breeding ground for fungal infections like athlete’s foot and therefore, it’s important to make sure you dry each foot properly.

Moisturise your feet

Keep your skin supple by applying moisturiser to your feet every day, though make sure to avoid in between your toes. This will also help prevent cracking and dryness which can lead to infections and open sores.

Use a thin layer of emollient cream on the tops and bottoms of your feet to keep them healthy. As recommended by Diabetes.co.uk, it is worth speaking with a healthcare professional on finding the best emollient cream for your skin.

If you notice any long-lasting dryness, cracking, or redness on your feet despite regular moisturising, ask your GP, consultant, or chiropodist for advice.

Trim your toenails

Whilst cutting your nails may seem like an easy task, for diabetics it is important to approach a nail trim with caution. This is because accidental damage to the skin can lead to a more complex injury and you might not notice any harm.

There are three key steps to bear in mind when cutting your toenails:

  • Trim your toenails regularly, though not too short
  • Use nail clippers and a nail file across the corners, avoiding scissors
  • Clean them delicately with a nail brush

If it’s a struggle to cut your own nails, ask a family member or see a foot specialist such as a chiropodist help you with this.

3. Choosing the Right Footwear and Socks

For people living with diabetes, wearing ill-fitting shoes and socks also poses a health risk so here’s how you can avoid that.

 Buying shoes

So, when choosing shoes, make sure that they feel comfortable and there’s room for you to move and wiggle your toes. The “toe box” should be deep and wide to prevent rubbing or cramping of your feet. This can cause new or make worse existing sores or blisters.

To make sure your shoes fit firmly on your feet when wearing them, make sure they have laces and buckles. Your shoes should support your body weight across both feet to minimise pressure. Try to avoid shoes with narrow or pointed toes or high heels because they don’t offer much protection or support to your feet.

Although you can order shoes online, it’s better to get your feet measured by a professional so that you’re sure you’re getting the right size. Let the shop assistant know if you experience diabetic foot swelling and go for larger shoes. Larger should mean they’ll fit more comfortably at night, the time when your feet are most likely to be swollen at night.

If you still don’t feel confident with purchasing the right shoes for you, there are a range of services which can support including the Society of Chiropodists and Podiatrists and the Society of Shoe Fitters.

Choosing the right socks

Your choice of socks can also help with your foot health. Avoid socks that have elastic bands around the top as they can restrict your circulation. Instead, try to buy seamless socks made from moisture-wicking materials like cotton, wool or specialised diabetic sock materials. They draw sweat away from your skin, keeping your feet dry and reducing the risk of fungal infections and blisters.

4. Professional Foot Examinations and Care

Another important part of any successful foot health regime are regular examinations from your doctor, consultant, or chiropodist. Even if you feel like everything is OK with your foot care regime, get them checked once a year.

If you do have a history of foot issues, neuropathy, or circulation problems, getting them checked every three to six months is better.

Prevention is always better than cure and these check-ups can identify potential issues a lot sooner when they’re most treatable.

Identifying and Treating Foot Problems Early

If, during your daily checks, you notice any of the following symptoms on the tops, bottoms or sides of your feet or in the spaces between your toes, seek medical help as a priority:

  • Cuts, blisters, or sores that don’t heal within a few days
  • Changes in skin colour or temperature
  • Redness, swelling, or warmth in your feet or legs
  • Persistent pain or tingling in your feet
  • Ingrown toenails or fungal infections
  • Any changes in the shape or colour of your feet or toes

Minor foot issues can quickly escalate in people with diabetes, so it’s always better to err on the side of caution and speak with your GP or consultant

The Role of Diet and Exercise in Foot Health

Diet and exercise are very important in managing foot health. Nutrient-rich foods and food groups like fruits, vegetables, whole grains, lean proteins, and healthy fats are a great way to manage your diabetes and stay on top of feet health. Try to get your vitamins and minerals from the food you eat, instead of from supplements.

Diabetes.co.uk recommends managing your carbohydrate intake evenly throughout the day, cutting back on salt and paying attention to portion sizes. You might want to ask your doctor to develop a personalised meal plan that suits your needs and preferences. Alternatively, you could go to a dietitian who specialises in diabetes.

Physical activity and exercise is great for your overall diabetes management. Staying active is proven to promote good circulation in your feet and improve your sensitivity to insulin. Aim for two-and-a-half hours a week worth of moderate-intensity aerobic exercise like brisk walking, swimming or cycling.

Check with your GP or consultant before you start any new exercise routine, especially if you’re currently experiencing issues with your feet.

Innovations in diabetic foot care

Positively, there have been recent major innovations in diabetic foot care products and treatments which are worth having on your radar, including diabetic shoe technology, 3D printed bandages and thermal imaging technology.

Perhaps the best known innovation is diabetic shoes. The research team from UTA developed footwear technology in 2022 which minimises risk by providing cushioning and extra width and depth to reduce pressure points on your feet. Muthu Wijesundara, Principal Research Scientist at University of Texas at Arlington Research Institute, commented on the research: “Diabetes is a leading cause of amputation worldwide, and there is a major role that technology can play to prevent its devastating effects. We are now one step closer to finding a solution to reduce risk of complications related to diabetic foot ulcers”

Researchers from Queen’s University Belfast also designed a new 3D printed bandage last year that can help treat diabetic foot ulcers. The bandage releases antibiotics into the ulcer in a controlled manner and the test results on patients are promising. Better still, the bandage also allows healthcare teams to monitor how well you’re healing without having to remove the dressing to take readings.

And finally, a team at the National Physical Laboratory (NPL) developed a new type of thermal imaging technology within 2023. It can capture the surface temperature of a patient’s entire foot meaning doctors are less likely to miss diabetic foot ulcers when treating patients.

Managing foot injuries and infections

If you notice any cuts, blisters, or sores on your feet, clean the affected area gently with warm water and mild soap. If your doctor has provided you with an antibiotic ointment, apply that after drying.

You should then cover the wound with a sterile dressing or bandage and keep a close eye on it over the coming days. If there are no signs of improvement, get in touch with your GP. They may prescribe antibiotics or other treatments to manage the infection.

Educational Resources and Support for Patients

There are a number of great resources for patients living with diabetic foot conditions online, including:

What to do if amputation is required?

If you require an amputation, you should try to do all you can to prepare yourself before you go in for surgery. The more you know, the better. Ask your GP or consultant about the type of amputation you’ll be undergoing and ask them to explain the practical impact it will have on your life.

You might want to find out the answers to questions like:

  • What you can expect before, during, and after surgery, including pain management options
  • How the surgery will affect your mobility and any rehabilitation or therapy you might benefit from.
  • Whether you’ll need to make any changes to your home or car to make life easier.
  • If there are any support groups or counsellors you can visit to address the emotional impact of undergoing an amputation.

Take all the time you need to get all the information and support when you discover that you’ll be going through a surgical procedure. Remember, your family and friends can also play an important role in providing support and assistance to you as you recover.

The ongoing impact of amputation

Comment from Trevor Ward:

“I’ve supported many individuals through legal proceedings, when an amputation could unfortunately have been prevented. During this time, I’ve seen first-hand the devastating impact losing a limb can have on a person’s life.

“Physically, there is the obvious limitation to mobility. Getting around and doing all the usual daily tasks suddenly becomes infinitely harder and more complicated than before. Wearing prosthetics can be uncomfortable, and amputees have to consider stump-care to avoid infections and try to alleviate discomfort. If an amputee uses a wheelchair, or any other mobility aid, standard-sized doorways can also become difficult to navigate. Public transport, driving a car, or even hailing a taxi – things that able-bodied individuals might take for granted – all carry their own complications.

“But aside from that, losing a limb is significantly emotionally challenging. Immediately following the amputation, and even in the time that passes, amputees might suffer feelings of withdrawal or isolation. Developing depressive episodes is not uncommon, and they may also suffer a genuine loss of their own identity. Continuing with their hobbies and passions post-injury can feel impossible – particularly if there is a physical element to the things they used to enjoy. Of course, adaptations can be made, and a comprehensive compensation package can help to bolster some of these hurdles – by providing suitable prosthetics for sport, or covering the costs of a rehabilitation package, for example.

“But what really makes a difference is the mindset of the individual, and the support of their wider network during the recovery phase and beyond. The rallying capability of a strong friends and family network really can make all the difference. And we see time and time again how important it is to pay close attention to any changes of mood within affected individuals, and for them to reach out to a trusted person in times of need.”

Diabetic amputation claims

NHS Resolution is the part of the health service that deals with the payment of compensation for medical negligence, including diabetes amputation claims. According to their report, two thirds of claims result in compensation payments with only a small percentage ever needing to be settled in court.

In over 35 years, we have represented many diabetic clients who underwent an amputation seeking compensation. The main reason why many of our clients’ amputation claim cases were successful is because we were able to prove that the healthcare professionals looking after them would have spotted the danger sooner if their diabetes had been managed correctly.

To talk to one of our legal professionals about pursuing a claim for fair compensation for your limb amputation, please call 0330 013 0247 or visit our contact page.

 

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