Managing Diabetic Foot Ulcers

Foot ulcers are patches of broken skin or open sores on the lower legs or feet. Below, we discuss why it is essential to manage ulcers correctly and the consequences of poor patient care.

People who live with diabetes are prone to foot ulcers, especially in areas of skin that are subject to pressure. At the same time, vascular complications and peripheral neuropathy – to which diabetic patients are susceptible – can curtail nerve function. Often, diminished sensation means that patients are unaware of the tissue damage.

People who have diabetes must keep their blood sugar levels under control to reduce the risk of these lesions. In particular, low glucose levels slow down the healing of tissue.

It is vital to treat diabetic foot ulcers promptly. In severe cases, an infection can aggravate the problem. Known as osteomyelitis, deep inflammation affects the surrounding bones and muscles. Sepsis can result in the need for amputation.

Recommendations to improve patient care standards

  • Early recognition. Patients with a foot ulcer should have regular wound assessments to identify deterioration at the earliest opportunity. Once identified, clinicians ought to adjust care plans to match patient needs.
  • Assessments and recordkeeping. Healthcare professionals must record the position, size and depth of the ulceration. Maintaining accurate records enables other clinicians to appreciate individual patient history and identify deterioration or healing progress.
  • Timely referral to specialists. Options include a multidisciplinary footcare team, tissue viability nurse, orthopaedic specialist and vascular surgeon.
  • Regular nursing attention. Dressings require routine changes to keep the ulcerated area clean and dry.
  • Guidance. To support healing, patients should receive advice to wear pressure-relieving footwear and rest their feet and legs whenever possible.

Only a relatively small proportion of UK hospitals have specialist footcare departments. Research charity Diabetes UK argues that widening multidisciplinary specialist teams in clinics across Britain would improve standards and prognoses. Apart from the positive outcome of fewer patients undergoing foot amputations, the NHS could reduce costs while freeing up operating theatre and ward capacity.

Facts and figures

According to information published by NHS England, diabetes is the most common cause of lower-limb loss throughout the UK. Ulcerated skin and associated complications lead to more than eight in ten foot amputations.

Adults living with diabetes are twenty times more predisposed to require this type of surgery. More than 9,000 procedures take place every year in the UK. Disquietingly, after a first amputation, they are more likely than to need another, compared to people without diabetes.

Summary

In conclusion, healthcare trusts should put adequate procedures and effective care plans in place. Equally, medical professionals must know how to identify diabetic foot ulcers and appreciate the importance of timely treatment.