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Poor diabetes foot checks increasing risk of amputation

Almost a third of patients not informed about their risk of foot problems at annual foot check

Ingrid Torjesen

Monday, 15 December 2014

A significant number of patients with diabetes are not receiving appropriate checks and appropriate advice about the risks diabetes poses to their feet, which could be putting them at increased risk of amputation, according to research carried out by Diabetes UK.

In its online survey of 6,696 people with diabetes, almost a third (32 per cent) said they had not been informed about their level of risk of foot problems at the annual foot check. The same proportion said they were not given advice about foot care and almost one in five people (18 per cent) said they did not have their feet checked for corns, calluses and changes in shape.

Many respondents admitted they often leave their foot check without any information as to why the checks are done, what changes to look out for, or day to day foot care advice.

Of the 1,476 people who stated that they had been told they were at an increased risk of foot problems, almost two thirds (62 per cent) reported that they had not been referred to a foot protection team or a podiatrist (which is what the National Institute for Health and Care Excellence recommends). One per cent of people said they did not even remove their socks or tights at their check.

One respondent commented: “My check was done at a retinopathy clinic but it was just a cursory look at my feet and even though I said I was suffering from numbness nothing was done or written down. I had to follow it up myself and was eventually referred to a hospital foot clinic.”

Another said: “It would appear that if you pass the foot touching with a 'stick' test, then all is fine, regardless of the fact that you have pain in the feet and numbness in the toes.”

Barbara Young, chief executive of Diabetes UK, said: “The annual foot check is very much a first line of defence against amputation, and clearly it is not working as well as it should. We know that early treatment can make all the difference when it comes to avoiding amputation, so it is vital that we take action to address this. We want the NHS to ensure that everyone who carries out the foot check understands how to do it and has the time to do it properly. The check must also include telling all people with diabetes about their level of risk of foot problems so they are properly informed and supported to take care of their feet properly.”

Up to 80 per cent of diabetes-related amputations in England each year are preventable, and the charity has warned that inadequate foot checks are part of the reason that so many amputations happen unnecessarily.

As part of its Putting Feet First campaign, the charity is calling for Clinical Commissioning Groups (CCGs), which are responsible for health services in their area, to make sure healthcare professionals carrying out the annual foot check are trained to do so and are given the time to carry it out thoroughly. The charity also wants people with diabetes to know what a good foot check looks like so they can make sure they are getting one.

Ms Young said: “Getting the foot checks right would have a real impact on the high amputation rate in the UK but, crucially, we need to recognise that this is not going to fix the problem on its own. We need a drive to improve the annual foot check to be part of a wider focus on diabetes-related amputation, which needs to look at all the care people with diabetes are getting, from the foot care information they are given all the way through to hospital care for people with foot disease. Until this happens, we will continue to see the unfolding tragedy of thousands of people a year having to endure amputations that could be avoided.”

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