By Lucy Mason
A leading podiatric surgeon is calling for specialist ‘fast response’ foot teams and a ‘Foot Helpline’ to drastically improve treatment for diabetics.
Dr David Armstrong, first US Podiatry Fellow of the Royal College of Physicians and Surgeons of Glasgow, also wants to see cancer style centres of excellence for feet where diabetics can be rapidly screened and put into the right risk category.
A team approach with GPs, nurses, podiatrists and vascular surgeons all working together to manage and prevent wounds is essential he says. And he claims it will lead to a reduction in the number of amputations.
According to the BMJ, diabetes is now responsible for 4 million deaths every year – overtaking HIV and Aids.
Diabetic foot complications are common, complicated and costly. The cost of diabetic foot is greater than the five most costly cancers – greater than breast cancer, colorectal, lung, prostate cancer and leukaemia.
Statistics show the most common reason diabetics are hospitalised is not for the likes of cancer or heart disease but foot ulcers. Up to 60 per cent of those with an ulcer go on to develop an infection and 20 per cent of those will have some level of amputation.
Dr Armstrong says: “Diabetes is the Cinderella of diseases. It sits in the shadows not attracting the headlines or attention it needs.
“But it is affecting younger and younger people and older and older people. It is an epidemic that is not going away and is a tremendous burden on the NHS and other health services around the world.”
Dr Armstrong, professor of surgery and director of the University of Arizona’s Southern Arizona Limb Salvage Alliance (SALSA), believes the answers lie in developing multi-disciplinary teams tackling the problem together.
He says: “A team approach is the way forward. In diabetes, the foot is prone to acute and chronic complications so effective management requires an interdisciplinary effort involving podiatry, vascular surgery and good nursing.
“Diabetic foot ulcer is often the first serious complication in diabetes. We need to rapidly screen people and get them into the right risk category from the start. If we can do this, it means we can identify problems before they start. It sounds simple but the hard part is changing policy.
“Scotland is a world leader in developing multi-disciplinary teams and it’s the way forward. In the past 15 years, foot screenings in Scotland have more than tripled and we can see big benefits. Now most people get screened but in the past only 25 per cent of them would do.
“Working together can have a dramatic impact on whether or not there’s an amputation. When teams don’t exist there’s a higher likelihood that people will not get the treatment that they need – and they may end up losing a leg.”
He believes that there should be centres of excellence for feet around the UK and specialist foot teams in every hospital.
“Every hospital should have access to a network like this,” he says. “Just as there are regional cardio centres of excellence, we need a network of specialist foot centres with teams working together and ready to mobilise just as they would for a patient undergoing a heart attack.
“We are trained as physicians and surgeons to specialise so we tend to isolate ourselves in silos. It takes energy to fight this. The energy needs to come from the doctors and nurses and politicians and policy makers and providers that care about the problem and patients too.”
Dr Armstrong believes that greater investment is crucial.
He says: “We had an issue in Arizona when podiatric care was hit by fiscal cutbacks. The result was a dramatic rise in the hospitalisation of people with diabetic foot complications. When you take something away from people there’s a significant and lasting impact on public health.”
A Foot Helpline would also be of benefit both in raising awareness of symptoms and providing frontline advice.
Dr Armstrong says: “Diabetics are not paying enough attention to their feet and it’s easy for them to waste quietly away. They lose feeling in their feet which is profoundly debilitating.
“Most people if they stepped on a nail and hurt themselves would go straight to A&E. With diabetes, we see people who are walking around for days with an equivalent wound who haven’t even noticed.
“Diseases like Ebola take centre stage when they are out there killing lots of people. But the fact is that for the first time more people in the developed world are dying from non-infectious diseases, like diabetes.
“Diabetes is an epidemic. To fight it, we have to work together.”