Health

Wednesday 3 September 2014

Fall in diabetic foot amputations but a rise in leg ulcers

Number of people with diabetes who had to have a foot amputated fell by 21 last year

The number of people with diabetes who had to have a foot amputated fell by 21 last year despite more diabetics being diagnosed.

However, there has been an increase in hospitalisations and discharges for leg ulcers due to more people having the disease.

This means that health professionals involved in the care of diabetics need to ensure they are alert to make a timely referral for specialist treatment. A diabetic foot ulcer is an open sore that develops on the feet of people with diabetes.

High blood sugar causes damage to the nerves and the blood vessels, particularly in the feet. The reduced sensation of the nerves increases the risk of developing an ulcer, and the reduced blood supply means the ulcer is more likely to become infected.

The infection is likely to further restrict blood supply, leading to gangrene-decay and death of body tissues.

Once gangrene has developed, it is sometimes necessary to amputate the affected limb to prevent the spread of infection and further damage to healthy tissue.

The fall in amputations last year brings the number who lost a foot due to these complications to 344, a figure which remains very high.

It is the third year to see an improvement in the figures – in 2010 there were 402 of these surgeries and this dropped to 392 in 2011, going down to 365 in 2012.

The improvement is being seen since the introduction of the National Diabetes Foot-Care Screening Programme by the HSE which allows diabetics more access to podiatrists who are specialists in this area.

Foot complications are almost completely preventable by regular screening of diabetics and by early intervention by podiatrists.

Diabetes Ireland estimates that there is a direct inpatient cost of €30,000 per diabetes patient who has to have a full or partial lower limb amputation.

Added to that sum is the direct outpatient costs, social welfare bills and housing alteration grants.

At the end of last year only half of the 16 podiatry posts had been filled although the HSE had committed €1m to the scheme.

Diabetics are urged to have routine foot checks and to look after their feet.

* Check both feet daily – make sure you check between all of your toes. Look for skin damage, hard skin, the ball of the foot, places where bones stick out or where shoes or socks may rub.

* Wash with warm – not hot – water. You may not be able to feel heat with your feet, so test the water with your hands first. Avoid soaking too long in water, since waterlogged sores take longer to heal. Dry your feet straight away, and remember to dry gently between all of your toes.

* Make sure shoes fit well. Even the slightest rubbing can cause a blister that turns into a sore that becomes infected and may never heal. Before buying or putting on the shoes check them for rough seams, sharp edges or other objects that could hurt your feet. In addition, break your shoes in gradually.

* Always wear shoes or slippers and wear socks with your shoes. Wear thicker socks to pad your feet and cushion any callouses or sore spots.

* Tell your doctor about any changes in sensation in your toes, feet or legs. Speak up if you notice pain, tingling, pins-and-needles, numbness or any other unusual signs.

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