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Why we should take diabetic foot ulcers more seriously


Prof Paul Chadwick

Clinical Director, College of Podiatry and Foot in Diabetes UK – Recognised by the Tissue Viability Society and the Legs Matter Campaign as an expert in the care of the Diabetic Foot

According to research, approximately 50% of people with diabetic ulcers will be dead within five years. This shocking statistic shows the importance of foot health.

Diabetic foot ulcers might not carry the same significance as heart attacks or cancer to the public, but the reality is they can be just as deadly. A patient  who suffers with a foot ulceration will face an increased risk of early death that could rise to a mortality rate of 50% within five years. With this type of ulceration, foot care and prevention really could be limb- and life-saving.

For those who are affected, foot ulcers are often the result of another complication of diabetes; a loss of sensation within the feet known as neuropathy.

If you have heard of the saying, ‘God’s greatest gift is pain’, then you can understand that a lack of sensation in the feet and legs can prove problematic.

Ulcers become a ticking time bomb

Professor Paul Chadwick is the Clinical Director, College of Podiatry. He explains: “When patients suffer from neuropathy, things like taking a hot bath, wearing ill-fitting shoes or simply walking on an existing ulcer can create – or further exacerbate – foot problems.

“We have seen a massive increase in the number of people with diabetes in the UK, which –coupled with an over 30% drop in podiatry students coming through, which may be linked to the loss of bursary funding – is causing a ticking time-bomb. But if we can increase knowledge of foot care and prevention among those living with diabetes, then we could save lives.”

Diabetic foot ulcers are a marker of increased risk of death

Diabetic foot ulcers are taken incredibly serious in the NHS, indeed they are a marker of an increased risk of mortality. Once a foot ulcer has been seen by a GP or nurse, the 24 hour referral process kicks in which means you should have an appointment to see a podiatrist within 48-hours.

Depending on the level of care needed, you could then be referred to an in-hospital multi-disciplinary team made up of a podiatrist, surgeon and other specialists who aim to heal an uncomplicated ulcer within 12 weeks.

Go straight to your GP, podiatrist or nurse

Professor Chadwick supports this approach: “Studies show that once in the hands of a multi-disciplinary team, outcomes are much improved, but timing is everything. It is so important to see your GP or podiatrist straight away, but usually patients ‘don’t want to bother them’, which can really complicate matters down the line.”

Indeed for Professor Chadwick, it is that first line of defence – the podiatrist ­– that people need to get to as podiatrists can diagnose the right management needed. Whether that includes antibiotics for infection dressings to manage excess discharge and insoles or devices to reduce pressure when walking, the dressing forms part of a ‘jigsaw approach’ that enables the patient to recover quicker.

Anyone with diabetes is entitled to a foot MOT each year, with their General Practice, who will identify early warning signs and should refer them on to a foot protection team who can help prevent the person developing a foot ulcer

Professor Chadwick believes diabetes-related foot ulceration is the ‘Cinderella’ of complications, and the College of Podiatry has joined the Legs Matter movement to help people recognise the early warning signs before they lead to ulceration, amputation, cardiovascular issues and overall, a reduced mortality.

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